Provider Demographics
NPI:1003032442
Name:WALTER, MICHAELLA J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAELLA
Middle Name:J
Last Name:WALTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CROOKS RD
Mailing Address - Street 2:STE. 3
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3300
Mailing Address - Country:US
Mailing Address - Phone:248-629-6071
Mailing Address - Fax:248-629-6073
Practice Address - Street 1:750 S OLD WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6600
Practice Address - Country:US
Practice Address - Phone:248-792-6570
Practice Address - Fax:248-792-6574
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1100326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP56370OtherMEDICARE PTAN