Healthcare Provider Details

I. General information

NPI: 1346545704
Provider Name (Legal Business Name): STEPHEN EDWARD WATERS D.C., LIC.AC., D.N.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SE SADDLEBROOK CIR
LEES SUMMIT MO
64082-4944
US

IV. Provider business mailing address

4200 SE SADDLEBROOK CIR
LEES SUMMIT MO
64082-4944
US

V. Phone/Fax

Practice location:
  • Phone: 816-898-4414
  • Fax: 816-817-0200
Mailing address:
  • Phone: 816-898-4414
  • Fax: 816-817-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: