Provider Demographics
NPI:1629253869
Name:WATERS, KATHRYN C (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:C
Last Name:WATERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:C
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1047 HORN LANE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404
Mailing Address - Country:US
Mailing Address - Phone:541-968-5908
Mailing Address - Fax:
Practice Address - Street 1:1047 HORN LANE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404
Practice Address - Country:US
Practice Address - Phone:541-968-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2660111N00000X
OROR 2660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor