Provider Demographics
NPI:1114015328
Name:WATERS, PAMELA JILL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JILL
Last Name:WATERS
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 1:3229 RANKIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1418
Mailing Address - Country:US
Mailing Address - Phone:214-265-8192
Mailing Address - Fax:
Practice Address - Street 1:3229 RANKIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1418
Practice Address - Country:US
Practice Address - Phone:214-265-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor