MEDICARE: DANIEL K WATTERS 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	4808	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417958687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL K WATTERS DC

Provider Business Mailing Address
First Line	:	350 N MAIN ST
Second Line	:
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-1532
Country	:	US
Telephone Number	:	610-282-4777
Fax Number	:	610-282-0631

Provider Business Practice Location Address
First Line	:	350 N MAIN ST
Second Line	:
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-1532
Country	:	US
Telephone Number	:	610-282-4777
Fax Number	:	610-282-0631

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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