Provider Demographics
NPI:1336373638
Name:ROBERT E WATKINS JR
Entity Type:Organization
Organization Name:ROBERT E WATKINS JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:239-590-9555
Mailing Address - Street 1:7051 CYPRESS TER
Mailing Address - Street 2:#106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8822
Mailing Address - Country:US
Mailing Address - Phone:239-590-9555
Mailing Address - Fax:866-254-8158
Practice Address - Street 1:7051 CYPRESS TER
Practice Address - Street 2:#106
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8822
Practice Address - Country:US
Practice Address - Phone:239-590-9555
Practice Address - Fax:866-254-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55775OtherBCBS - LEE COUNTY (FORT MYERS)
FL55775AOtherBCBS HENDRY COUNTY (LABELLE)