Provider Demographics
NPI:1902236979
Name:WATSON, SARAH J (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:J
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 1:1011 LAKE ST
Mailing Address - Street 2:SUITE #216
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1148
Mailing Address - Country:US
Mailing Address - Phone:888-476-5171
Mailing Address - Fax:
Practice Address - Street 1:1011 LAKE ST
Practice Address - Street 2:SUITE #216
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1148
Practice Address - Country:US
Practice Address - Phone:888-476-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03801149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor