Provider Demographics
NPI:1053337832
Name:WATSON, TODD E (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:WATSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FOX RUN SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2534
Mailing Address - Country:US
Mailing Address - Phone:302-836-6150
Mailing Address - Fax:302-836-6294
Practice Address - Street 1:12 FOX RUN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2534
Practice Address - Country:US
Practice Address - Phone:302-836-6150
Practice Address - Fax:302-836-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-914111N00000X
DEF1-0000658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE7433301OtherAETNA