Provider Demographics
NPI:1053499335
Name:WATTO, DAVID M (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:WATTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 ROUTE 104
Mailing Address - Street 2:SUITE 30
Mailing Address - City:MT PLEASANT MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:17853-8752
Mailing Address - Country:US
Mailing Address - Phone:570-539-2600
Mailing Address - Fax:570-539-0066
Practice Address - Street 1:8638 ROUTE 104
Practice Address - Street 2:SUITE 30
Practice Address - City:MT PLEASANT MILLS
Practice Address - State:PA
Practice Address - Zip Code:17853-8752
Practice Address - Country:US
Practice Address - Phone:570-539-2600
Practice Address - Fax:570-539-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004466L111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU10145Medicare UPIN
PA644291Medicare ID - Type Unspecified