Provider Demographics
NPI:1154668291
Name:WATTS CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:WATTS CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-218-4924
Mailing Address - Street 1:2751 ENTERPRISE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2751 ENTERPRISE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8256
Practice Address - Country:US
Practice Address - Phone:386-218-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU82648Medicare UPIN