Healthcare Provider Details

I. General information

NPI: 1750643433
Provider Name (Legal Business Name): WALTERS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 E CROSSROADS LN SUITE 302
OLATHE KS
66062-1674
US

IV. Provider business mailing address

2011 E CROSSROADS LN SUITE 302
OLATHE KS
66062-1674
US

V. Phone/Fax

Practice location:
  • Phone: 913-738-7667
  • Fax:
Mailing address:
  • Phone: 913-738-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberT03149
License Number StateKS

VIII. Authorized Official

Name: DR. JUSTIN R WALTERS
Title or Position: OWNER/ CHIROPRACTOR
Credential: D.C.
Phone: 913-738-7667