Provider Demographics
NPI:1386812477
Name:WATKINS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:WATKINS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:VERBOVANEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-764-3000
Mailing Address - Street 1:165 CENTRAL AVE N
Mailing Address - Street 2:P.O. BOX 39
Mailing Address - City:WATKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55389-4505
Mailing Address - Country:US
Mailing Address - Phone:320-764-3000
Mailing Address - Fax:
Practice Address - Street 1:165 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:WATKINS
Practice Address - State:MN
Practice Address - Zip Code:55389-4505
Practice Address - Country:US
Practice Address - Phone:320-764-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03766Medicare PIN