Provider Demographics
NPI:1396088563
Name:WATTERS, EMILY DENA (DC)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:DENA
Last Name:WATTERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:DENA
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7809 SE SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4169
Mailing Address - Country:US
Mailing Address - Phone:541-968-0393
Mailing Address - Fax:
Practice Address - Street 1:3804 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4330
Practice Address - Country:US
Practice Address - Phone:503-213-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5144111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor