Provider Demographics
NPI:1306519582
Name:WATERMAN, ASHLEY T (DC)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:T
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4763
Mailing Address - Country:US
Mailing Address - Phone:401-441-2600
Mailing Address - Fax:
Practice Address - Street 1:201 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4763
Practice Address - Country:US
Practice Address - Phone:401-441-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECR2753OtherLICENSE