MEDICARE: NICHOLAS JOSHUA 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	6434	CO

General Provider Information

NPI Number	:	1750684759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JOSHUA WATSON D.C.

Provider Business Mailing Address
First Line	:	916 GRAND AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3661
Country	:	US
Telephone Number	:	970-947-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 GRAND AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3661
Country	:	US
Telephone Number	:	970-947-1240
Fax Number	:

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

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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