Provider Demographics
NPI:1447557483
Name:WILLIAMS, KERRY CHANT (DC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:CHANT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:K
Other - Middle Name:CHANT
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1134 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3582
Mailing Address - Country:US
Mailing Address - Phone:208-356-8818
Mailing Address - Fax:208-356-0458
Practice Address - Street 1:1134 BOND AVE
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3582
Practice Address - Country:US
Practice Address - Phone:208-356-8818
Practice Address - Fax:208-356-0458
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7809367-1202111N00000X
IDCHIA-1667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor