Healthcare Provider Details

I. General information

NPI: 1164505723
Provider Name (Legal Business Name): LYNN EDGAR WALSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AIRPORT RD SUITE 103
MILFORD DE
19963-6421
US

IV. Provider business mailing address

6028 OLD SHAWNEE RD
MILFORD DE
19963-3355
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-0622
  • Fax: 302-422-0520
Mailing address:
  • Phone: 302-422-0622
  • Fax: 302-422-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000180
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: