Organization Active NPI

Kevin S & Tina S Watt

  • Chiropractor
  • Lodi, CA
National Provider Identifier
1104059203
Registry record updated Oct 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC0240270 Issued in CA
Legal business name
KEVIN S & TINA S WATT
Practice address
1822 W Kettleman LN
Suite 5
Lodi, CA 95242-4218
Phone
(209) 334-2366
Fax
(209) 334-2377
NPI assigned
Aug 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin S Watt, D.C.
Title
Owner
Phone
(209) 334-2366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC0240270 CA Primary

Addresses

Primary practice location

1822 W Kettleman LN
Suite 5
Lodi, CA 95242-4218

Mailing address

1822 W Kettleman LN
Suite 5
Lodi, CA 95242-4218
Phone (209) 334-2366

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256860800000",
    "number": "1104059203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 W KETTLEMAN LN",
            "address_2": "SUITE 5",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424218",
            "telephone_number": "209-334-2366",
            "fax_number": "209-334-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1822 W KETTLEMAN LN",
            "address_2": "SUITE 5",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424218",
            "telephone_number": "209-334-2366",
            "fax_number": "209-334-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN S & TINA S WATT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2009-10-30",
        "status": "A",
        "authorized_official_last_name": "WATT",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-334-2366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC0240270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.