Provider Demographics
NPI:1659641975
Name:WATTERS, BRIAN M (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
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 1:11691 FALL CREEK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9448
Mailing Address - Country:US
Mailing Address - Phone:317-688-1711
Mailing Address - Fax:317-288-4041
Practice Address - Street 1:11691 FALL CREEK RD
Practice Address - Street 2:STE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-9448
Practice Address - Country:US
Practice Address - Phone:317-688-1711
Practice Address - Fax:317-288-4041
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002617A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor