Provider Demographics
NPI:1003880543
Name:HART, WALTER JOSEPH III (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOSEPH
Last Name:HART
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17290 PRESTON RD
Mailing Address - Street 2:STE. 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-4026
Mailing Address - Country:US
Mailing Address - Phone:972-931-8777
Mailing Address - Fax:972-250-6301
Practice Address - Street 1:17290 PRESTON RD
Practice Address - Street 2:STE. 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4026
Practice Address - Country:US
Practice Address - Phone:972-931-8777
Practice Address - Fax:972-250-6301
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600915Medicare ID - Type Unspecified