Provider Demographics
NPI:1851633317
Name:WATERS, MARCUS DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:DAVID
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 1:10051 LAKE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4870
Mailing Address - Country:US
Mailing Address - Phone:530-308-7784
Mailing Address - Fax:
Practice Address - Street 1:10051 LAKE AVE STE 3
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4870
Practice Address - Country:US
Practice Address - Phone:530-308-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32555OtherMEDICAL LICENSE