Provider Demographics
NPI:1669610127
Name:WATKINS, UTASHA NICHOLE (DC)
Entity type:Individual
Prefix:DR
First Name:UTASHA
Middle Name:NICHOLE
Last Name:WATKINS
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 1:5000 RIVERSIDE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5621
Mailing Address - Country:US
Mailing Address - Phone:434-822-2222
Mailing Address - Fax:434-822-2101
Practice Address - Street 1:5000 RIVERSIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5621
Practice Address - Country:US
Practice Address - Phone:434-822-2222
Practice Address - Fax:434-822-2101
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11884413OtherANTHEM