Provider Demographics
NPI:1174804587
Name:ORR, WILLIAM S (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:ORR
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 1:2110 MCCULLOCH BLVD N
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6711
Mailing Address - Country:US
Mailing Address - Phone:928-453-7570
Mailing Address - Fax:
Practice Address - Street 1:2110 MCCULLOCH BLVD N
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6711
Practice Address - Country:US
Practice Address - Phone:928-453-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor