MEDICARE: WALTON CS-XIII

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	2000153532	MO

General Provider Information

NPI Number	:	1669570115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTON CS-XIII

Provider Business Mailing Address
First Line	:	110 E 1ST NORTH ST
Second Line	:
City	:	CARLINVILLE
State	:	IL
Zip	:	62626-1505
Country	:	US
Telephone Number	:	217-854-3300
Fax Number	:	217-854-4546

Provider Business Practice Location Address
First Line	:	1381 HIGH ST STE 211
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-6446
Country	:	US
Telephone Number	:	636-390-9990
Fax Number	:	636-390-9994

Authorized Official
Title or Position	:	EXECUTOR
Name	:	DAMON WALTON
Credential	:	DC
Telephone Number	:	217-854-3300

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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