Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 5144 | OR |
NPI | 1396088563 |
---|---|
Provider Name | Dr. Emily Dena Watters |
First Address | Portland, OR 97215-4169 |
Second Address | Portland, OR 97214-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 09/06/2020 |