Individual
DR. GONZZO WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
18670 WILLAMETTE DRIVE, SUITE 101, WEST LINN, OR 97068
(503) 697-7463
(503) 697-2743
Mailing address
18670 WILLAMETTE DRIVE, SUITE 101, WEST LINN, OR 97068
(503) 697-7463
(503) 697-2743
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
272973
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158842
—
OR
01
—
350555
MEDICARE RR PARTB
UT
01
—
808027000
BLUE CROSS BLUE SHIELD
OR
Enumeration date
08/04/2006
Last updated
04/28/2008
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