Healthcare Provider Details

I. General information

NPI: 1609919976
Provider Name (Legal Business Name): JASON TODD WATTS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8228 PARK MEADOWS DR SUITE A
LONE TREE CO
80124-2761
US

IV. Provider business mailing address

8228 PARK MEADOWS DR SUITE A
LONE TREE CO
80124-2761
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-7766
  • Fax: 303-790-9486
Mailing address:
  • Phone: 303-790-7766
  • Fax: 303-790-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5275
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: