Healthcare Provider Details

I. General information

NPI: 1083072383
Provider Name (Legal Business Name): WALTERS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 WOLFRUM RD
WELDON SPRING MO
63304-7795
US

IV. Provider business mailing address

13948 REFLECTION DR
BALLWIN MO
63021-8054
US

V. Phone/Fax

Practice location:
  • Phone: 217-836-6855
  • Fax:
Mailing address:
  • Phone: 217-836-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2016003220
License Number StateMO

VIII. Authorized Official

Name: DR. JOSEPH M WALTERS
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 217-836-6855