Provider Demographics
NPI:1306972146
Name:WATERS CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:WATERS CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-277-0612
Mailing Address - Street 1:115 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5522
Mailing Address - Country:US
Mailing Address - Phone:717-277-8061
Mailing Address - Fax:717-277-0613
Practice Address - Street 1:115 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5522
Practice Address - Country:US
Practice Address - Phone:717-277-8061
Practice Address - Fax:717-277-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007292L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50013490OtherBLUE CROSS
20060432OtherAMERI HEALTH MERCY
0763651000OtherINDEPENDANCE BLUE CROSS
PA1696780OtherBLUE SHIELD
410721OtherHEALTH ASSURANCE
410721OtherHEALTH AMERICA
485449OtherAETNA
PA088787Medicare UPIN