Provider Demographics
NPI:1699782409
Name:WATSON, JOHN HOWARD (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HOWARD
Last Name:WATSON
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 1:232 N BROADWAY ST
Mailing Address - Street 2:STE 102
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1792
Mailing Address - Country:US
Mailing Address - Phone:812-662-6656
Mailing Address - Fax:812-662-6172
Practice Address - Street 1:232 N BROADWAY ST
Practice Address - Street 2:STE 102
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1792
Practice Address - Country:US
Practice Address - Phone:812-662-6656
Practice Address - Fax:812-662-6172
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089366OtherANTHEM
IN181330Medicare ID - Type Unspecified