Provider Demographics
NPI:1730201609
Name:WATTERSON, LORI JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:JEAN
Last Name:WATTERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MAIN AVE.
Mailing Address - Street 2:P.O. BOX 289
Mailing Address - City:ONSET
Mailing Address - State:MA
Mailing Address - Zip Code:02558
Mailing Address - Country:US
Mailing Address - Phone:508-273-0002
Mailing Address - Fax:508-273-0081
Practice Address - Street 1:5 MAIN AVE.
Practice Address - Street 2:
Practice Address - City:ONSET
Practice Address - State:MA
Practice Address - Zip Code:02558
Practice Address - Country:US
Practice Address - Phone:508-273-0002
Practice Address - Fax:508-273-0081
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1957111N00000X
RI00357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY 36630OtherBCBS
MAY 36630OtherBCBS
MAU 83645Medicare UPIN