Provider Demographics
NPI:1780743104
Name:WATSON, TRACY DAWN (DC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:DAWN
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 1:1080 MINNESOTA AVE
Mailing Address - Street 2:#2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:408-294-2285
Mailing Address - Fax:408-294-2840
Practice Address - Street 1:1080 MINNESOTA AVE
Practice Address - Street 2:#2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-294-2285
Practice Address - Fax:408-294-2840
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor