Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 637 | TN |
N | 111NS0005X | Chiropractic Sports Physician | 637 | TN |
NPI | 1033198080 |
---|---|
Provider Name | Dr. Charles Richard Williams |
First Address | Maryville, TN 37804-5284 |
Second Address | Maryville, TN 37804-5284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3040283 | BCBSTN (01) | |
5455013 | AETNA (01) | |
U24201 | (02) |