Healthcare Provider Details

I. General information

NPI: 1295785301
Provider Name (Legal Business Name): JOHN A. WATTS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/07/2011
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

PO BOX 731
AURORA MO
65605-0731
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:
Title or Position:
Credential:
Phone: