Healthcare Provider Details

I. General information

NPI: 1144362856
Provider Name (Legal Business Name): BRIAN PATRICK WALSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 EBER BLVD STE 102
W MELBOURNE FL
32904-8768
US

IV. Provider business mailing address

1051 EBER BLVD STE 102
W MELBOURNE FL
32904-8768
US

V. Phone/Fax

Practice location:
  • Phone: 321-728-1387
  • Fax: 321-728-1386
Mailing address:
  • Phone: 321-728-1387
  • Fax: 321-728-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH7872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: