MEDICARE: CHERIE SHARESE WATTS 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	CH8375	FL

General Provider Information

NPI Number	:	1588833834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIE SHARESE WATTS D.C

Provider Business Mailing Address
First Line	:	6771 NW DAFFODIL LN
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1416
Country	:	US
Telephone Number	:	305-522-7117
Fax Number	:

Provider Business Practice Location Address
First Line	:	6771 NW DAFFODIL LN
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1416
Country	:	US
Telephone Number	:	305-522-7117
Fax Number	:

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	03/19/2014

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