Healthcare Provider Details

I. General information

NPI: 1497838304
Provider Name (Legal Business Name): WALSH CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 N LEROY SUITE F
FENTON MI
48430-2795
US

IV. Provider business mailing address

1537 N LEROY ST
FENTON MI
48430-2795
US

V. Phone/Fax

Practice location:
  • Phone: 810-629-6500
  • Fax: 810-629-6616
Mailing address:
  • Phone: 810-629-6500
  • Fax: 810-629-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008999
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL THOMAS WALSH
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 810-629-6500