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General NPI Number Information
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NPI Number | 1912133919
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Entity Type | Individual
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Provider Name | JENNIFER M WATTERS D.C., L.AC.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 710 WILSHIRE BLVD STE 314
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City | SANTA MONICA
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State | CA
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Zip | 90401-1724
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Country | US
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Telephone | 310-977-5779
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 E OCEAN BLVD UNIT 309
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City | LONG BEACH
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State | CA
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Zip | 90802-5534
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Country | US
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Telephone | 310-977-5779
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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 | 31258
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 13668
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License Number State | CA
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