Provider Demographics
NPI:1194223404
Name:WATSON, HARTMAN SAMUEL IAN (DC)
Entity Type:Individual
Prefix:DR
First Name:HARTMAN
Middle Name:SAMUEL IAN
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 1:1211 S MAIN ST STE 300H
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0818
Mailing Address - Country:US
Mailing Address - Phone:817-343-9224
Mailing Address - Fax:
Practice Address - Street 1:1211 S MAIN ST STE 300H
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-343-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor