Provider Demographics
NPI:1487667895
Name:MCWILLIAMS CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:MCWILLIAMS CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-483-0779
Mailing Address - Street 1:1500 SENECA INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9049
Mailing Address - Country:US
Mailing Address - Phone:419-483-0779
Mailing Address - Fax:419-483-0779
Practice Address - Street 1:1500 SENECA INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9049
Practice Address - Country:US
Practice Address - Phone:419-483-0779
Practice Address - Fax:419-483-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0868324Medicaid
1699729467Medicare UPIN
OHMC9346211Medicare ID - Type Unspecified