Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3177 | SC |
Y | 111N00000X | Chiropractor | CH10056 | FL |
N | 111N00000X | Chiropractor | CHIR008295 | GA |
NPI | 1003000415 |
---|---|
Provider Name | Dr. Marshall Dean Webster |
First Address | Lake City, FL 32025-1607 |
Second Address | Lake City, FL 32025-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 08/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
IA771A | (02) | FL |