MEDICARE: PATRICK A. WALDING DC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	A5562

General Provider Information

NPI Number	:	1174874259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK A. WALDING DC PC

Provider Business Mailing Address
First Line	:	3133 FLOYD BLVD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51108-1419
Country	:	US
Telephone Number	:	712-239-2700
Fax Number	:	712-239-2702

Provider Business Practice Location Address
First Line	:	3133 FLOYD BLVD
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51108-1419
Country	:	US
Telephone Number	:	712-239-2700
Fax Number	:	712-239-2702

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK WALDING
Credential	:	DC
Telephone Number	:	712-239-2700

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	09/28/2012

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