1134426760 NPI number — DR. RYAN SCOTT WALTON D.C.

Table of content: DR. RYAN SCOTT WALTON D.C. (NPI 1134426760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134426760 NPI number — DR. RYAN SCOTT WALTON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTON
Provider First Name:
RYAN
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1134426760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1651 CAREY AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEYENNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82001-4423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-426-4321
Provider Business Mailing Address Fax Number:
307-426-4320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 CAREY AVE
Provider Second Line Business Practice Location Address:
STE 1C
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82001-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-426-4321
Provider Business Practice Location Address Fax Number:
307-426-4320
Provider Enumeration Date:
02/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6645 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 726 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com