Healthcare Provider Details

I. General information

NPI: 1508993437
Provider Name (Legal Business Name): PATRICK JAMES WALSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 COMMERCE BLVD SUITE 128
ROHNERT PARK CA
94928-2179
US

IV. Provider business mailing address

6020 COMMERCE BLVD SUITE 128
ROHNERT PARK CA
94928-2179
US

V. Phone/Fax

Practice location:
  • Phone: 707-584-5678
  • Fax: 707-584-7020
Mailing address:
  • Phone: 707-584-5678
  • Fax: 707-584-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: