Healthcare Provider Details

I. General information

NPI: 1205192796
Provider Name (Legal Business Name): JOHN A. WATTS, DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S MADISON AVE
AURORA MO
65605-1426
US

IV. Provider business mailing address

131 S MADISON AVE
AURORA MO
65605-1426
US

V. Phone/Fax

Practice location:
  • Phone: 417-678-3272
  • Fax: 417-678-3272
Mailing address:
  • Phone: 417-678-3272
  • Fax: 417-678-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006688
License Number StateMO

VIII. Authorized Official

Name: JOHN WATTS
Title or Position: OWNER
Credential: D.C.
Phone: 417-678-3272