Provider Demographics
NPI:1720358047
Name:BRIAN WATTERS DC LLC
Entity Type:Organization
Organization Name:BRIAN WATTERS DC LLC
Other - Org Name:INDY MUSCLE & JOINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-517-8543
Mailing Address - Street 1:11691 FALL CREEK RD STE 110
Mailing Address - Street 2:
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 STE 110
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002617A111N00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty