Provider Demographics
NPI:1053320655
Name:WATERBURY, ROBIN LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LYNN
Last Name:WATERBURY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 SHELBY DR
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3435
Mailing Address - Country:US
Mailing Address - Phone:731-377-5550
Mailing Address - Fax:
Practice Address - Street 1:1400 SHELBY DR
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3435
Practice Address - Country:US
Practice Address - Phone:731-377-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor