Provider Demographics
NPI:1386814267
Name:WILLIAMS, BLAKE AARON (DC)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:AARON
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 1:709 RIVER BEND DR.
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:IA
Mailing Address - Zip Code:52033
Mailing Address - Country:US
Mailing Address - Phone:319-321-4530
Mailing Address - Fax:
Practice Address - Street 1:1211 12TH AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-2412
Practice Address - Country:US
Practice Address - Phone:319-321-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor