Provider Demographics
NPI:1134397532
Name:WATSON, NICOLE FREEMAN (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:FREEMAN
Last Name:WATSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 EL CAMINO REAL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002
Mailing Address - Country:US
Mailing Address - Phone:650-596-5657
Mailing Address - Fax:650-596-5659
Practice Address - Street 1:1601 EL CAMINO REAL
Practice Address - Street 2:SUITE 301
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3948
Practice Address - Country:US
Practice Address - Phone:650-596-5657
Practice Address - Fax:650-596-5659
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor