Provider Demographics
NPI:1992280309
Name:WATERMAN, GABRIEL (DC)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:WATERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 UNDERWOOD AVE APT 604A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8843
Mailing Address - Country:US
Mailing Address - Phone:620-794-4653
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY OFFICE BLVD STE 14
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6247
Practice Address - Country:US
Practice Address - Phone:620-794-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor