Provider Demographics
NPI:1639237209
Name:WATSON, JAMES C (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:WATSON
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 1:3890 STATE ROUTE 5 AND 20
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8101
Mailing Address - Country:US
Mailing Address - Phone:585-394-2186
Mailing Address - Fax:
Practice Address - Street 1:3890 STATE ROUTE 5 AND 20
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8101
Practice Address - Country:US
Practice Address - Phone:585-394-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17720BMedicare PIN