Healthcare Provider Details

I. General information

NPI: 1750693610
Provider Name (Legal Business Name): PATRICK JOSEPH WALTER D.C., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 INTERNATIONAL BLVD STE 701
OAKLAND CA
94601-1506
US

IV. Provider business mailing address

1811 BAY ST
ALAMEDA CA
94501-1104
US

V. Phone/Fax

Practice location:
  • Phone: 510-867-7943
  • Fax: 510-952-8265
Mailing address:
  • Phone: 510-867-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number15422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number15422
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number15422
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number15422
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number15422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: