Provider Demographics
NPI:1841730538
Name:WATSON, KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
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 1:6402 COTTONMOUTH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-6115
Mailing Address - Country:US
Mailing Address - Phone:254-913-3206
Mailing Address - Fax:
Practice Address - Street 1:7800 N MOPAC EXPY STE 340
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8962
Practice Address - Country:US
Practice Address - Phone:512-346-5567
Practice Address - Fax:512-231-1087
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor