Healthcare Provider Details

I. General information

NPI: 1396873162
Provider Name (Legal Business Name): WALTERS' CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 COORS BLVD NW SUITE A7
ALBUQUERQUE NM
87120-2785
US

IV. Provider business mailing address

6200 COORS BLVD NW SUITE A7
ALBUQUERQUE NM
87120-2785
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-0708
  • Fax: 505-899-0707
Mailing address:
  • Phone: 505-899-0708
  • Fax: 505-899-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1354
License Number StateNM

VIII. Authorized Official

Name: DR. BRADLEY DARIN WALTERS
Title or Position: PRESIDENT
Credential: DC
Phone: 505-899-0708