Provider Demographics
NPI:1073630976
Name:WATERS, KIMBERLY KNOWLTON (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KNOWLTON
Last Name:WATERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:BETH
Other - Last Name:KNOWLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:51 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4810
Mailing Address - Country:US
Mailing Address - Phone:603-673-6133
Mailing Address - Fax:
Practice Address - Street 1:51 ELM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4810
Practice Address - Country:US
Practice Address - Phone:603-673-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH775-1106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor