Basic Information
| Provider Information | |||||||||
| NPI: | 1134355175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | MARSHALL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 WOLF CREEK DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622262367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182334458 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13 WOLF CREEK DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622262367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182334458 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2009012055 | MO | N | Chiropractic Providers | Chiropractor | 363AS0400X | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.