Provider Demographics
NPI:1013202639
Name:WATTERSON, LAURA ANNE JUSSILA (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE JUSSILA
Last Name:WATTERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19924 JETTON RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8250
Mailing Address - Country:US
Mailing Address - Phone:704-896-8446
Mailing Address - Fax:
Practice Address - Street 1:19924 JETTON RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8250
Practice Address - Country:US
Practice Address - Phone:704-896-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3649111N00000X
NC4207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor