Provider Demographics
NPI:1023135985
Name:WILLIAMSON, BARRY EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:EDWARD
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2329
Mailing Address - Country:US
Mailing Address - Phone:630-682-0575
Mailing Address - Fax:630-682-0581
Practice Address - Street 1:400 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2329
Practice Address - Country:US
Practice Address - Phone:630-682-0575
Practice Address - Fax:630-682-0581
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor