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General NPI Number Information
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NPI Number | 1114045861
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Entity Type | Individual
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Provider Name | BRENT EVERETT WATSON D.C
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 316 N MAIN ST
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City | BROOKFIELD
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State | MO
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Zip | 64628-1601
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Country | US
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Telephone | 660-258-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 113 MAPLE ST
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City | BUCKLIN
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State | MO
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Zip | 64631-9113
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Country | US
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Telephone | 660-695-3635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2006032871
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License Number State | MO
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