Provider Demographics
NPI:1962801613
Name:WILLIAMS, FREDRICK THOMAS JR (DC)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 153072
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-3072
Mailing Address - Country:US
Mailing Address - Phone:813-434-1045
Mailing Address - Fax:813-434-1259
Practice Address - Street 1:501 S FALKENBURG RD STE A2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8040
Practice Address - Country:US
Practice Address - Phone:813-434-1045
Practice Address - Fax:813-434-1259
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor