Healthcare Provider Details

I. General information

NPI: 1134149370
Provider Name (Legal Business Name): KENNETH F WALSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 2ND ST
BELLEVUE IA
52031-1227
US

IV. Provider business mailing address

111 N 2ND ST
BELLEVUE IA
52031-1227
US

V. Phone/Fax

Practice location:
  • Phone: 563-872-4104
  • Fax: 563-872-5461
Mailing address:
  • Phone: 563-872-4104
  • Fax: 563-872-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4423
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: