Provider Demographics
NPI:1144228651
Name:WATSON, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WATSON
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 1:800 QUINTANA RD
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2300
Mailing Address - Country:US
Mailing Address - Phone:805-772-6131
Mailing Address - Fax:805-772-5281
Practice Address - Street 1:800 QUINTANA RD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2300
Practice Address - Country:US
Practice Address - Phone:805-772-6131
Practice Address - Fax:805-772-5281
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20026111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20026Medicare ID - Type Unspecified
T89636Medicare UPIN