Provider Demographics
NPI:1396856142
Name:WATINS, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WATINS
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 1:330 W 58TH ST STE 407
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1820
Mailing Address - Country:US
Mailing Address - Phone:212-765-6470
Mailing Address - Fax:212-333-7346
Practice Address - Street 1:330 W 58TH ST STE 407
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1820
Practice Address - Country:US
Practice Address - Phone:212-765-6470
Practice Address - Fax:212-333-7346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX63341Medicare PIN