NPIMap

Organization Active NPI

Brian Watters DC LLC

Doing business as Indy Muscle & Joint Clinic

  • Chiropractor
  • Indianapolis, IN
National Provider Identifier
1720358047
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
08002617A Issued in IN
Legal business name
BRIAN WATTERS DC LLC
Doing business as
Indy Muscle & Joint Clinic
Practice address
11691 Fall Creek Rd Ste 110
Indianapolis, IN 46256-9448
Phone
(317) 688-1711
Fax
(317) 288-4041
NPI assigned
Jan 3, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Brian Watters, D.C.NPI 1659641975
Title
Member
Phone
(317) 517-8543

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 08002617A IN Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

11691 Fall Creek Rd Ste 110
Indianapolis, IN 46256-9448

Mailing address

11691 Fall Creek Rd Ste 110
Indianapolis, IN 46256-9448
Phone (317) 688-1711

Other names 1

  • Indy Muscle & Joint Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200430001955 IN Part B Supplier - Clinic/Group Practice 9032549274 Receives reassigned benefits from 3 practitioners
Practice locations: Indianapolis, IN

National Provider Directory

National Provider Directory

Locations

11691 Fall Creek Rd
Ste 110
Indianapolis, IN 46256
Phone (317) 450-5347

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1720358047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11691 FALL CREEK RD STE 110",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462569448",
            "telephone_number": "317-688-1711",
            "fax_number": "317-288-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11691 FALL CREEK RD STE 110",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462569448",
            "telephone_number": "317-688-1711",
            "fax_number": "317-288-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN WATTERS DC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-03",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "WATTERS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "317-517-8543",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08002617A",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indy Muscle & Joint Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.