Provider Demographics
NPI:1942335187
Name:WILLIAM B WATERS D.C.P.A.
Entity Type:Organization
Organization Name:WILLIAM B WATERS D.C.P.A.
Other - Org Name:DR. BUCK WATERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-983-7986
Mailing Address - Street 1:5513 BAY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-9518
Mailing Address - Country:US
Mailing Address - Phone:850-983-7986
Mailing Address - Fax:850-983-7986
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLCH004090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050314200Medicaid
FL70302OtherBCBS
FL70302OtherBCBS
FLEG392AMedicare PIN