Healthcare Provider Details

I. General information

NPI: 1568559995
Provider Name (Legal Business Name): PAUL M. WALTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N WATER ST
GENEVA IL
60134-2218
US

IV. Provider business mailing address

23 N WATER ST
GENEVA IL
60134-2218
US

V. Phone/Fax

Practice location:
  • Phone: 630-262-1090
  • Fax: 630-262-1091
Mailing address:
  • Phone: 630-262-1090
  • Fax: 630-262-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: