Basic Information
| Provider Information | |||||||||
| NPI: | 1881085330 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALTERS CHIROPRACTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1747 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320671747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048874708 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1482 3RD ST S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322506310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042463232 | ||||||||
| FaxNumber: | 9042463626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2015 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | WALTERS | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR OF CHIROPRACTIC | ||||||||
| AuthorizedOfficialTelephone: | 9048874708 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH 11395 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.