Provider Demographics
NPI:1235312984
Name:WATERS, WILLIAM BARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BARRY
Last Name:WATERS
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 1:1602 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5522
Mailing Address - Country:US
Mailing Address - Phone:850-435-7777
Mailing Address - Fax:850-435-3132
Practice Address - Street 1:1602 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-5522
Practice Address - Country:US
Practice Address - Phone:850-435-7777
Practice Address - Fax:850-435-3132
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH004090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050314200Medicaid
FL050314200Medicaid
FL70302ZMedicare PIN