Provider Demographics
NPI:1427228220
Name:WATTERSON, SETH DAVID (DC)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:DAVID
Last Name:WATTERSON
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 1:4839 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211
Mailing Address - Country:US
Mailing Address - Phone:503-789-3516
Mailing Address - Fax:
Practice Address - Street 1:4839 NE MARTIN LUTHER KING JR BLVD STE 207
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3388
Practice Address - Country:US
Practice Address - Phone:503-789-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3803111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician