Provider Demographics
NPI:1699729467
Name:MCWILLIAMS, MARK ALAN (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:MCWILLIAMS
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 1:6697 YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9790
Mailing Address - Country:US
Mailing Address - Phone:419-483-6919
Mailing Address - Fax:
Practice Address - Street 1:1500 SENECA INDUSTRIAL PKWY W
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0868324Medicaid
OH0868324Medicaid