Provider Demographics
NPI:1588720692
Name:WATKINS, CHARLES EDGAR II (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDGAR
Last Name:WATKINS
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:299 BELLE TERRE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2425
Mailing Address - Country:US
Mailing Address - Phone:985-653-9606
Mailing Address - Fax:985-653-8396
Practice Address - Street 1:299 BELLE TERRE BLVD STE E
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2425
Practice Address - Country:US
Practice Address - Phone:985-653-9606
Practice Address - Fax:985-653-8396
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C211Medicare UPIN