Provider Demographics
NPI:1457462392
Name:WATKINS, JOSHUA TAIJ (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TAIJ
Last Name:WATKINS
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 1:6001 EGAN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4921
Mailing Address - Country:US
Mailing Address - Phone:952-440-4553
Mailing Address - Fax:952-440-4573
Practice Address - Street 1:6001 EGAN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4921
Practice Address - Country:US
Practice Address - Phone:952-440-4553
Practice Address - Fax:952-440-4573
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457693400OtherMINNESOTA CARE
MN67G17WAOtherBLUE CROSS BLUE SHIELD
MN67G17WAOtherBLUE CROSS BLUE SHIELD