Provider Demographics
NPI:1558668871
Name:WATTERS, CHAD CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:CHRISTOPHER
Last Name:WATTERS
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 1:7300 FRANCE AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4525
Mailing Address - Country:US
Mailing Address - Phone:952-835-0006
Mailing Address - Fax:
Practice Address - Street 1:7300 FRANCE AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4525
Practice Address - Country:US
Practice Address - Phone:952-835-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor