Basic Information
Provider Information
NPI: 1003000415
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEBSTER
FirstName: MARSHALL
MiddleName: DEAN
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XCH10056FLY Chiropractic ProvidersChiropractor 
111N00000XCHIR008295GAN Chiropractic ProvidersChiropractor 
111N00000X3177SCN Chiropractic ProvidersChiropractor 

No ID Information.


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