Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-007292-L | PA |
N | 111NX0100X | Occupational Health | AJ-007292-L | PA |
NPI | 1902877293 |
---|---|
Provider Name | Stephen Michael Waters |
First Address | Lebanon, PA 17042-7482 |
Second Address | Lebanon, PA 17042-7482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0763651000 | INDEPENDENCE BLUE CROSS (01) | PA |
1033499 | ASHN (01) | PA |
1696780 | HIGHMARK BLUE SHIELD (01) | PA |
50013490 | CAPITAL BLUE CROSS (01) | PA |
U73946 | (02) | PA |