Provider Demographics
NPI:1699793950
Name:WATSON, STEPHEN CHRISTOPHER (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTOPHER
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 1:2425 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1462
Mailing Address - Country:US
Mailing Address - Phone:650-969-1032
Mailing Address - Fax:650-969-1107
Practice Address - Street 1:2425 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1462
Practice Address - Country:US
Practice Address - Phone:650-969-1032
Practice Address - Fax:650-969-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12306Medicare UPIN