Provider Demographics
NPI:1891199097
Name:WATSON, RAYMOND ANDRE (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ANDRE
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 1:4065 S MARYLAND PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7538
Mailing Address - Country:US
Mailing Address - Phone:702-885-3553
Mailing Address - Fax:
Practice Address - Street 1:10925 SOUTHERN HIGHLANDS PKWY
Practice Address - Street 2:UNIT 2150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4302
Practice Address - Country:US
Practice Address - Phone:702-885-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01539111NN1001X, 111NR0400X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic