MEDICARE: DR. CHASE GARRETT WATERS DAOM, MTCM, LAC,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC17367	CA
2	171100000X	Acupuncturist	AC186066	OR

General Provider Information

NPI Number	:	1609310671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHASE GARRETT WATERS DAOM, MTCM, LAC,

Provider Business Mailing Address
First Line	:	879 41ST AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-4420
Country	:	US
Telephone Number	:	831-428-3198
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 NE SANDY BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5336
Country	:	US
Telephone Number	:	503-249-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2016
Last Update Date	:	01/20/2021

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