| Brian Watters Dc Llc | |
|
11691 Fall Creek Rd Ste 110 Indianapolis IN 46256-9448 | |
| (317) 688-1711 | |
| (317) 288-4041 |
| Full Name | Brian Watters Dc Llc |
|---|---|
| Speciality | Chiropractor |
| Location | 11691 Fall Creek Rd Ste 110, Indianapolis, Indiana |
| Authorized Official Name and Position | Brian Watters (MEMBER) |
| Authorized Official Contact | 3175178543 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Watters Dc Llc 11691 Fall Creek Rd Ste 110 Indianapolis IN 46256-9448 Ph: (317) 688-1711 | Brian Watters Dc Llc 11691 Fall Creek Rd Ste 110 Indianapolis IN 46256-9448 Ph: (317) 688-1711 |
| NPI Number | 1720358047 |
|---|---|
| Provider Enumeration Date | 01/03/2012 |
| Last Update Date | 02/04/2020 |
| Medicare PECOS PAC ID | 9032549274 |
|---|---|
| Medicare Enrollment ID | O20200430001955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720358047 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 111N00000X | Chiropractor | 08002617A (Indiana) | Primary |
| Provider Name | Brian Michael Watters |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1659641975 PECOS PAC ID: 4981871209 Enrollment ID: I20120126000670 |
| Provider Name | John Theriot |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1134865371 PECOS PAC ID: 3274911391 Enrollment ID: I20220602000207 |
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