Provider Demographics
NPI:1609310671
Name:WATERS, CHASE GARRETT (DAOM, MTCM, LAC,)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:GARRETT
Last Name:WATERS
Suffix:
Gender:M
Credentials:DAOM, MTCM, LAC,
Other - Prefix:
Other - First Name:CHASE
Other - Middle Name:GARRETT
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, MTCM
Mailing Address - Street 1:879 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4420
Mailing Address - Country:US
Mailing Address - Phone:831-428-3198
Mailing Address - Fax:
Practice Address - Street 1:4160 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5336
Practice Address - Country:US
Practice Address - Phone:503-249-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17367171100000X
ORAC186066171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist