Healthcare Provider Details

I. General information

NPI: 1326235953
Provider Name (Legal Business Name): LONNIE R. WALTERS, DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W MOUNT VERNON BLVD
MOUNT VERNON MO
65712-1940
US

IV. Provider business mailing address

316 W MOUNT VERNON BLVD
MOUNT VERNON MO
65712-1940
US

V. Phone/Fax

Practice location:
  • Phone: 417-461-1155
  • Fax: 417-461-1155
Mailing address:
  • Phone: 417-461-1155
  • Fax: 417-461-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LONNIE RICHARD WALTERS
Title or Position: PRESIDENT
Credential: DC
Phone: 417-258-2863