MEDICARE: DR. MARC A. WALTERS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC007867L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054233	OTHER	PA	MEDICARE

General Provider Information

NPI Number	:	1316945918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC A. WALTERS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 111
Second Line	:
City	:	GALETON
State	:	PA
Zip	:	16922
Country	:	US
Telephone Number	:	570-724-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1414
Country	:	US
Telephone Number	:	814-435-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	05/06/2019

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