| Entity Name: | WILLIAM B. WATERS, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Apr 1983 (42 years ago) |
| Document Number: | G32498 |
| FEI/EIN Number | 592350314 |
| Address: | WILLIAM B WATERS D.C.,P.A., 5513 BAY MEADOWS DR, MILTON, FL, 32583, US |
| Mail Address: | WILLIAM B WATERS D.C.,P.A., 5513 BAY MEADOWS DR, MILTON, FL, 32583, US |
| ZIP code: | 32583 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942335187 | 2007-02-21 | 2014-07-19 | 5513 BAY MEADOWS DR, MILTON, FL, 325839518, US | 1602 N 9TH AVE, PENSACOLA, FL, 325035522, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 850-983-7986 |
| Fax | 8509837986 |
| Phone | +1 850-435-7777 |
| Fax | 8504353132 |
Authorized person
| Name | MRS. DONNA M WATERS |
| Role | BUSINESS MANAGER |
| Phone | 8509837986 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | FLCH004090 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 050314200 |
| State | FL |
| Issuer | BCBS |
| Number | 70302 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Waters Donna M | Agent | 5513 BAY MEADOWS DR, MILTON, FL, 32583 |
| Name | Role | Address |
|---|---|---|
| WATERS WILLIAM B | Director | 5513 BAYMEADOWS DR., MILTON, FL, 32583 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-03-22 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
