Provider Demographics
NPI:1437103603
Name:WATTERSON, LUCAS CHADD (DC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:CHADD
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 1:965 HARTMAN RUN RD
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-292-7740
Mailing Address - Fax:304-292-7741
Practice Address - Street 1:965 HARTMAN RUN RD
Practice Address - Street 2:SUITE 1101
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-292-7740
Practice Address - Fax:304-292-7741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87439Medicare UPIN
4082911Medicare ID - Type Unspecified