Provider Demographics
NPI:1558401158
Name:WATERSTONE, MERRILLEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MERRILLEE
Middle Name:
Last Name:WATERSTONE
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 1:2180 CAREFREE CIR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1973
Mailing Address - Country:US
Mailing Address - Phone:770-565-1721
Mailing Address - Fax:770-321-2326
Practice Address - Street 1:2180 CAREFREE CIR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1973
Practice Address - Country:US
Practice Address - Phone:770-565-1721
Practice Address - Fax:770-321-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor