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General NPI Number Information
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NPI Number | 1801531827
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Entity Type | Individual
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Provider Name | MADISYN WALTER DC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 11576 W US HIGHWAY 30 # C
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City | WANATAH
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State | IN
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Zip | 46390-9300
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Country | US
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Telephone | 219-851-7767
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Fax |
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Provider Business Mailing Address
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Address Line | 6679 W 1600 S
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City | WANATAH
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State | IN
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Zip | 46390-9758
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Country | US
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Telephone | 219-851-7767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08003296A
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License Number State | IN
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