Provider Demographics
NPI: | 1346397080 |
---|---|
Name: | WILLIAMSON, DENNIS WAYNE (DC) |
Entity type: | Individual |
Prefix: | DR |
First Name: | DENNIS |
Middle Name: | WAYNE |
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: | 4702 NORTHWEST HWY |
Mailing Address - Street 2: | |
Mailing Address - City: | GARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75043-4912 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-270-5333 |
Mailing Address - Fax: | 972-270-5335 |
Practice Address - Street 1: | 4702 NORTHWEST HWY |
Practice Address - Street 2: | |
Practice Address - City: | GARLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75043-4912 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-270-5333 |
Practice Address - Fax: | 972-270-5335 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-04 |
Last Update Date: | 2021-12-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 10235 | 111NS0005X, 111NI0013X, 111NX0100X, 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | |
No | 111NS0005X | Chiropractic Providers | Chiropractor | Sports Physician |
No | 111NI0013X | Chiropractic Providers | Chiropractor | Independent Medical Examiner |
No | 111NX0100X | Chiropractic Providers | Chiropractor | Occupational Health |