Basic Information
| Provider Information | |||||||||
| NPI: | 1003000415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1478 SW SISTERS WELCOME RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320251607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3865901752 | ||||||||
| FaxNumber: | 3862699676 | ||||||||
| Practice Location | |||||||||
| Address1: | 1478 SW SISTERS WELCOME RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320251607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3865901752 | ||||||||
| FaxNumber: | 3862699676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 3177 | SC | N | Chiropractic Providers | Chiropractor | 111N00000X | CHIR008295 | GA | N | Chiropractic Providers | Chiropractor | 111N00000X | CH10056 | FL | Y | Chiropractic Providers | Chiropractor |
No ID Information.