Provider Demographics
NPI:1710983648
Name:WATTS, TERRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:WATTS
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 1:2751 ENTERPRISE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8256
Mailing Address - Country:US
Mailing Address - Phone:386-218-4924
Mailing Address - Fax:
Practice Address - Street 1:2751 ENTERPRISE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8256
Practice Address - Country:US
Practice Address - Phone:386-218-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00553000111N00000X
FLCH9871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU82648Medicare UPIN