MEDICARE: DR. PATRICK A WALDING 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	111N00000X	Chiropractor	A05562	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	16587	OTHER	IA	BCBS
4	22490	OTHER	IA	SIOUX VALLEY HEALTH PLAN

General Provider Information

NPI Number	:	1699745661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK A WALDING D.C.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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