Provider Demographics
NPI:1528136819
Name:WATKINS, DEBRA SIEBEN (DC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SIEBEN
Last Name:WATKINS
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 1:340 DARDANELLI LN
Mailing Address - Street 2:STE 23
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-626-9880
Mailing Address - Fax:
Practice Address - Street 1:340 DARDANELLI LN
Practice Address - Street 2:STE 23
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-626-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 22856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0228560Medicare ID - Type Unspecified