Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC20026 | CA |
NPI | 1144228651 |
---|---|
Provider Name | Dr. John M Watson |
First Address | Morro Bay, CA 93442-2300 |
Second Address | Morro Bay, CA 93442-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 28/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T89636 | (02) |