Provider Demographics
NPI:1376702704
Name:WATKINS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WATKINS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:985-653-9606
Mailing Address - Street 1:299 BELLE TERRE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2425
Mailing Address - Country:US
Mailing Address - Phone:985-653-9606
Mailing Address - Fax:985-653-8396
Practice Address - Street 1:299 BELLE TERRE BLVD STE E
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2425
Practice Address - Country:US
Practice Address - Phone:985-653-9606
Practice Address - Fax:985-653-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C211Medicare UPIN