MEDICARE: PAUL DWIGHT WALTON D.C.

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	111NS0005X	Sports Physician Chiropractor	16583	CA

General Provider Information

NPI Number	:	1235135393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DWIGHT WALTON D.C.

Provider Business Mailing Address
First Line	:	50 VASHELL WAY
Second Line	:	STE 300
City	:	ORINDA
State	:	CA
Zip	:	94563-3020
Country	:	US
Telephone Number	:	925-253-9446
Fax Number	:	925-253-9505

Provider Business Practice Location Address
First Line	:	50 VASHELL WAY
Second Line	:	STE 300
City	:	ORINDA
State	:	CA
Zip	:	94563-3020
Country	:	US
Telephone Number	:	925-253-9446
Fax Number	:	925-253-9505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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