Provider Demographics
NPI:1215094420
Name:ABBOTT, WILLIAM JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:ABBOTT
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 1:133 W MAIN ST
Mailing Address - Street 2:SUITE110
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1547
Mailing Address - Country:US
Mailing Address - Phone:248-449-2802
Mailing Address - Fax:248-449-2796
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:SUITE110
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1547
Practice Address - Country:US
Practice Address - Phone:248-449-2802
Practice Address - Fax:248-449-2796
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7582717OtherAETNA
MI95 0 H22 3790OtherBLUE CROSS BLUE SHIELD
MIP13800001Medicare ID - Type Unspecified