Provider Demographics
NPI:1700999455
Name:WATSON, JOHN G (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
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 1:1534 HAYWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791
Mailing Address - Country:US
Mailing Address - Phone:828-693-3319
Mailing Address - Fax:828-693-1271
Practice Address - Street 1:1534 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2338
Practice Address - Country:US
Practice Address - Phone:828-693-3319
Practice Address - Fax:828-693-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908908Medicaid
NC08908OtherBCBS
NCT64472Medicare UPIN
NC8908908Medicaid