MEDICARE: DR. JAY DEVIN WATTS D.C.

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	5188240-1202	UT

General Provider Information

NPI Number	:	1821185729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY DEVIN WATTS D.C.

Provider Business Mailing Address
First Line	:	1059 S 1480 W
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-8443
Country	:	US
Telephone Number	:	801-390-3290
Fax Number	:	801-417-8383

Provider Business Practice Location Address
First Line	:	1972 W 5400 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-1459
Country	:	US
Telephone Number	:	801-313-1400
Fax Number	:	801-417-8383

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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