MEDICARE: DR. TERRY L WATTS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00553000	NJ
2	111N00000X	Chiropractor	CH9871	FL

General Provider Information

NPI Number	:	1710983648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY L WATTS DC

Provider Business Mailing Address
First Line	:	2751 ENTERPRISE RD
Second Line	:	SUITE 103
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8256
Country	:	US
Telephone Number	:	386-218-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 ENTERPRISE RD
Second Line	:	SUITE 103
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8256
Country	:	US
Telephone Number	:	386-218-4924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/04/2010

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