Provider Demographics
NPI:1699985036
Name:RONEL R. WILLIAMS D.C.
Entity type:Organization
Organization Name:RONEL R. WILLIAMS D.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-334-3180
Mailing Address - Street 1:607 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21550-3734
Mailing Address - Country:US
Mailing Address - Phone:301-334-3180
Mailing Address - Fax:301-334-3182
Practice Address - Street 1:607 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKE PARK
Practice Address - State:MD
Practice Address - Zip Code:21550-3734
Practice Address - Country:US
Practice Address - Phone:301-334-3180
Practice Address - Fax:301-334-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131153000Medicaid
MDX64958Medicare UPIN
WV0131153000Medicaid