Healthcare Provider Details

I. General information

NPI: 1619035300
Provider Name (Legal Business Name): TODD B WALTERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 VICTOR RD NW
LANCASTER OH
43130
US

IV. Provider business mailing address

1619 VICTOR RD NW
LANCASTER OH
43130-7883
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-5390
  • Fax: 740-653-2808
Mailing address:
  • Phone: 740-653-5390
  • Fax: 740-653-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1714
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001286
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4112
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: