Provider Demographics
NPI:1164505723
Name:WALSH, LYNN EDGAR (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:EDGAR
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 1:6028 OLD SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-3355
Mailing Address - Country:US
Mailing Address - Phone:302-422-0622
Mailing Address - Fax:302-422-0520
Practice Address - Street 1:800 AIRPORT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6421
Practice Address - Country:US
Practice Address - Phone:302-422-0622
Practice Address - Fax:302-422-0520
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEMR- WA140158OtherPROVIDER
DEMR- U01969Medicare UPIN
DEG01043Medicare ID - Type UnspecifiedMEDICARE PROVIDER