Healthcare Provider Details

I. General information

NPI: 1841390689
Provider Name (Legal Business Name): DANIEL PATRICK WALSH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S MAIN ST
CENTRAL SQUARE NY
13036-9779
US

IV. Provider business mailing address

544 S MAIN ST ROUTE 11 P.O. BOX 893
CENTRAL SQUARE NY
13036-9502
US

V. Phone/Fax

Practice location:
  • Phone: 315-668-3248
  • Fax: 315-676-3796
Mailing address:
  • Phone: 315-668-3248
  • Fax: 315-676-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010102-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: