Provider Demographics
NPI:1821536004
Name:CCW CHIROPRACTIC
Entity Type:Organization
Organization Name:CCW CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-577-9355
Mailing Address - Street 1:869 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6779
Mailing Address - Country:US
Mailing Address - Phone:405-577-9355
Mailing Address - Fax:405-577-9356
Practice Address - Street 1:869 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6779
Practice Address - Country:US
Practice Address - Phone:405-577-9355
Practice Address - Fax:405-577-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty