Provider Demographics
NPI:1881777902
Name:WATSON, CHERYL LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LAWRENCE
Last Name:WATSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1096 CONCORD PKWY N
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5902
Mailing Address - Country:US
Mailing Address - Phone:704-793-1405
Mailing Address - Fax:704-793-1410
Practice Address - Street 1:1096 CONCORD PKWY N
Practice Address - Street 2:SUITE 5
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5902
Practice Address - Country:US
Practice Address - Phone:704-793-1405
Practice Address - Fax:704-793-1410
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890856MMedicaid
NC2454292Medicare ID - Type Unspecified
NC890856MMedicaid