Provider Demographics
NPI:1124232905
Name:WALSH, PETER JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:WALSH
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 1:36 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1437
Mailing Address - Country:US
Mailing Address - Phone:973-477-3470
Mailing Address - Fax:
Practice Address - Street 1:36 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:TOWACO
Practice Address - State:NJ
Practice Address - Zip Code:07082-1437
Practice Address - Country:US
Practice Address - Phone:973-477-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00640400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor