Provider Demographics
NPI:1114994415
Name:WALTERS, DANIEL R (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:WALTERS
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 1:4600 PARK RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3670
Mailing Address - Country:US
Mailing Address - Phone:704-523-2367
Mailing Address - Fax:704-523-9937
Practice Address - Street 1:4600 PARK RD
Practice Address - Street 2:SUITE 380
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3670
Practice Address - Country:US
Practice Address - Phone:704-523-2367
Practice Address - Fax:704-523-9937
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908907Medicaid
NCT64283Medicare UPIN
NC8908907Medicaid