Provider Demographics
NPI:1477664340
Name:WATKINS FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:WATKINS FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:TAIJ
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-440-4553
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4204261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN67G17WAOtherBLUE CROSS BLUE SHIELD
MN457693400OtherMINNESOTA CARE
MN67G17WAOtherBLUE CROSS BLUE SHIELD
MNU88345Medicare UPIN