Basic Information
| Provider Information | |||||||||
| NPI: | 1659619351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4531 HARD SCRABBLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292298561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034198700 | ||||||||
| FaxNumber: | 8038656760 | ||||||||
| Practice Location | |||||||||
| Address1: | 4531 HARD SCRABBLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292298561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034198700 | ||||||||
| FaxNumber: | 8038656760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 3784 | SC | Y | Chiropractic Providers | Chiropractor |
No ID Information.