Provider Demographics
NPI:1497061717
Name:WATERMARK CHIROPRACTIC
Entity Type:Organization
Organization Name:WATERMARK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-696-9936
Mailing Address - Street 1:501 W EMMA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4412
Mailing Address - Country:US
Mailing Address - Phone:479-365-2488
Mailing Address - Fax:479-365-2489
Practice Address - Street 1:501 W EMMA AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4412
Practice Address - Country:US
Practice Address - Phone:479-365-2488
Practice Address - Fax:479-365-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1376698662OtherNPPES