1184672388 NPI number — WALSH CHIROPRACTIC CENTER P.C.

Table of content: (NPI 1184672388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184672388 NPI number — WALSH CHIROPRACTIC CENTER P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALSH CHIROPRACTIC CENTER P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184672388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1309 JAMESTOWN RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185-3380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-220-4917
Provider Business Mailing Address Fax Number:
757-220-5884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1139 PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-220-4917
Provider Business Practice Location Address Fax Number:
757-220-5884
Provider Enumeration Date:
05/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALSH
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
757-220-4917

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104555779 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1025361 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5898271 . This is a "GHI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7116255 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 317460 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 33369 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".