MEDICARE: DR. JOHN M WATSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC20026	CA

General Provider Information

NPI Number	:	1144228651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M WATSON DC

Provider Business Mailing Address
First Line	:	800 QUINTANA RD
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-2300
Country	:	US
Telephone Number	:	805-772-6131
Fax Number	:	805-772-5281

Provider Business Practice Location Address
First Line	:	800 QUINTANA RD
Second Line	:	SUITE 1-B
City	:	MORRO BAY
State	:	CA
Zip	:	93442-2300
Country	:	US
Telephone Number	:	805-772-6131
Fax Number	:	805-772-5281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/28/2010

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