Provider Demographics
NPI:1427868082
Name:WATKINS, MICHAEL T (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:WATKINS
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:MOAPA
Mailing Address - State:NV
Mailing Address - Zip Code:89025-0293
Mailing Address - Country:US
Mailing Address - Phone:314-703-2372
Mailing Address - Fax:
Practice Address - Street 1:3603 LAS VEGAS BLVD N STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0590
Practice Address - Country:US
Practice Address - Phone:702-867-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor