Provider Demographics
NPI:1003000415
Name:WEBSTER, MARSHALL DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:DEAN
Last Name:WEBSTER
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 1:1478 SW SISTERS WELCOME RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1607
Mailing Address - Country:US
Mailing Address - Phone:386-590-1752
Mailing Address - Fax:386-269-9676
Practice Address - Street 1:1478 SW SISTERS WELCOME RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1607
Practice Address - Country:US
Practice Address - Phone:386-590-1752
Practice Address - Fax:386-269-9676
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3177111N00000X
GACHIR008295111N00000X
FLCH10056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA771AMedicare UPIN