MEDICARE: WATSON CHIROPRACTIC INC.

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	111NN1001X	Nutrition Chiropractor	21161	CA

General Provider Information

NPI Number	:	1649206970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATSON CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	12304 ANETA ST
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5916
Country	:	US
Telephone Number	:	310-305-9697
Fax Number	:	310-305-9706

Provider Business Practice Location Address
First Line	:	12304 ANETA ST
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5916
Country	:	US
Telephone Number	:	310-305-9697
Fax Number	:	310-305-9706

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHIRLEY ANN WATSON
Credential	:	DC, CCN, DACBN, QME
Telephone Number	:	310-305-9697

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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