Provider Demographics
NPI:1700182219
Name:WATERMAN, DEVIN STANLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:STANLEY
Last Name:WATERMAN
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 1:3160 CROW CANYON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1382
Mailing Address - Country:US
Mailing Address - Phone:925-275-1990
Mailing Address - Fax:925-275-1993
Practice Address - Street 1:3160 CROW CANYON RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1382
Practice Address - Country:US
Practice Address - Phone:925-275-1990
Practice Address - Fax:925-275-1993
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor