Provider Demographics
NPI:1386703445
Name:WILLIAMS, KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:WILLIAMS
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 1:790A UNION ST
Mailing Address - Street 2:A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1307
Mailing Address - Country:US
Mailing Address - Phone:718-230-4842
Mailing Address - Fax:718-230-4834
Practice Address - Street 1:790A UNION ST
Practice Address - Street 2:A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1307
Practice Address - Country:US
Practice Address - Phone:718-230-4842
Practice Address - Fax:718-230-4834
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009347111N00000X
NY009347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96428Medicare UPIN
NYU96428Medicare UPIN
KW0X6H0610Medicare ID - Type Unspecified
NYX6H061Medicare PIN