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NPI Code Detail

MEDICARE: THE WALTON CLINIC, LTD

MEDICARE: THE WALTON CLINIC, LTD
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
1111N00000XChiropractor1099MN

General Provider Information

NPI Number : 1427334382
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE WALTON CLINIC, LTD
Provider Business Mailing Address
First Line : 6264 BOONE AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55428-2729
Country : US
Telephone Number : 651-442-1731
Fax Number :
Provider Business Practice Location Address
First Line : 6264 BOONE AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55428-2729
Country : US
Telephone Number : 651-442-1731
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ERIC GORDON KOEHLER
Credential : D.C.
Telephone Number : 651-442-1731
Provider Enumeration Date : 10/24/2011
Last Update Date : 10/24/2011

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Directions to “THE WALTON CLINIC, LTD ” Practice Location

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