Healthcare Provider Details

I. General information

NPI: 1144480294
Provider Name (Legal Business Name): JOHN SEXTON WALTERS L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 METRO PKWY SUITE 300
BLOOMINGTON MN
55425-1514
US

IV. Provider business mailing address

7800 METRO PKWY SUITE 300
BLOOMINGTON MN
55425-1514
US

V. Phone/Fax

Practice location:
  • Phone: 952-767-4910
  • Fax: 952-851-9618
Mailing address:
  • Phone: 952-767-4910
  • Fax: 952-851-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1343
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: