MEDICARE: DR. KENNETH RAY WATSON D.C.

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	111N00000X	Chiropractor	1669	NC
2	111N00000X	Chiropractor	19323	CA
3	111N00000X	Chiropractor	4713	TX
4	111N00000X	Chiropractor	6666	MI

General Provider Information

NPI Number	:	1346227030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RAY WATSON D.C.

Provider Business Mailing Address
First Line	:	3609 SOUTH BLVD.
Second Line	:	SUITE B
City	:	CHARLOTTE
State	:	NC
Zip	:	28209
Country	:	US
Telephone Number	:	704-529-1610
Fax Number	:	704-529-1611

Provider Business Practice Location Address
First Line	:	3609 SOUTH BLVD.
Second Line	:	SUITE B
City	:	CHARLOTTE
State	:	NC
Zip	:	28209
Country	:	US
Telephone Number	:	704-529-1610
Fax Number	:	704-529-1611

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/08/2007

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