Provider Demographics
NPI:1073640280
Name:HIRSBRUNNER, WALTER WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WAYNE
Last Name:HIRSBRUNNER
Suffix:
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 1:1845 WEST 4400 SOUTH
Mailing Address - Street 2:STE. 104
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3049
Mailing Address - Country:US
Mailing Address - Phone:801-731-6800
Mailing Address - Fax:801-731-6802
Practice Address - Street 1:1845 WEST 4400 SOUTH
Practice Address - Street 2:STE. 104
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3049
Practice Address - Country:US
Practice Address - Phone:801-731-6800
Practice Address - Fax:801-731-6802
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT166982-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor