1114233681 NPI number — MCWILLIAMS FAMILY CHIROPRACTIC, INC.

Table of content: ALEXIS CAROLINE CONNOLLY APRN (NPI 1235855735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114233681 NPI number — MCWILLIAMS FAMILY CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCWILLIAMS FAMILY CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114233681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4419 LITTLE BROOK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-5757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-284-8911
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4362 AUBURN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95841-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-481-6828
Provider Business Practice Location Address Fax Number:
916-481-6830
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCWILLIAMS
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
BENNING
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-284-8911

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC-30140 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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