Basic Information
| Provider Information | |||||||||
| NPI: | 1164604849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15811 AMBAUM BLVD SW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062428211 | ||||||||
| FaxNumber: | 2062420162 | ||||||||
| Practice Location | |||||||||
| Address1: | 15811 AMBAUM BLVD SW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062428211 | ||||||||
| FaxNumber: | 2062420162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2007 | ||||||||
| LastUpdateDate: | 04/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH00034837 | WA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 0274108 | 01 | WA | LABOR & INDUSTRIES | OTHER | 0226133 | 01 | WA | LABOR & INDUSTRIES | OTHER |