Provider Demographics
NPI:1114166238
Name:WATERSIDE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:WATERSIDE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-622-0062
Mailing Address - Street 1:2441 US HIGHWAY 98 W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5385
Mailing Address - Country:US
Mailing Address - Phone:850-622-0062
Mailing Address - Fax:850-622-0007
Practice Address - Street 1:2441 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5385
Practice Address - Country:US
Practice Address - Phone:850-622-0062
Practice Address - Fax:850-622-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty