Individual provider Active NPI

Fredrick Thomas Williams Jr., D.C.

  • Chiropractor
  • Tampa, FL
National Provider Identifier
1962801613
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH 11209 Issued in FL
Practice address
501 S Falkenburg Rd Ste A2
Tampa, FL 33619-8040
Phone
(813) 434-1045
Fax
(813) 434-1259
NPI assigned
Aug 19, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 11209 FL Primary

Addresses

Primary practice location

501 S Falkenburg Rd Ste A2
Tampa, FL 33619-8040

Mailing address

PO Box 153072
Tampa, FL 33684-3072
Phone (813) 434-1045

Other practice location 1

1484 Gulf To Bay Blvd
Clearwater, FL 33755-5358
Phone (813) 434-1045

Other practice location 2

1089 Ponce De Leon Blvd
Brooksville, FL 34601-1241
Phone (813) 434-1045

Other practice location 3

5912 Watson Rd
Riverview, FL 33578-3734
Phone (813) 434-1045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180725001039 FL Practitioner - Chiropractic 3476800244

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH 11209FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
American Relief Careline Current Accepting new patients
Kingdom Medical LLC CurrentSince Nov 17, 2024 Accepting new patients
Kingdom Chiropractic Chiropractor Past Accepting new patients

Locations

501 S Falkenburg Rd
Ste A2
Tampa, FL 33619
Phone (813) 434-1045

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1962801613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 153072",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336843072",
            "telephone_number": "813-434-1045",
            "fax_number": "813-434-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S FALKENBURG RD STE A2",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336198040",
            "telephone_number": "813-434-1045",
            "fax_number": "813-434-1259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1484 Gulf To Bay Blvd",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337555358",
            "country_code": "US",
            "telephone_number": "813-434-1045",
            "fax_number": "813-434-1259",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1089 Ponce De Leon Blvd",
            "address_purpose": "LOCATION",
            "city": "Brooksville",
            "state": "FL",
            "postal_code": "346011241",
            "country_code": "US",
            "telephone_number": "813-434-1045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5912 Watson Rd",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335783734",
            "country_code": "US",
            "telephone_number": "813-434-1045",
            "fax_number": "813-434-1259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "FREDRICK",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-19",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 11209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.