Provider Demographics
NPI:1609011824
Name:WATSON CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:WATSON CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZZO
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-697-7463
Mailing Address - Street 1:18670 WILLAMETTE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1796
Mailing Address - Country:US
Mailing Address - Phone:503-697-7463
Mailing Address - Fax:503-697-2743
Practice Address - Street 1:18670 WILLAMETTE DR
Practice Address - Street 2:101
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1796
Practice Address - Country:US
Practice Address - Phone:503-697-7463
Practice Address - Fax:503-697-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158842Medicaid
UT350555OtherMEDICARE RR PART B
OR808027000OtherBCBS
OR0000QGHGLMedicare PIN