Provider Demographics
NPI:1184672388
Name:WALSH CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:WALSH CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-220-4917
Mailing Address - Street 1:1309 JAMESTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3380
Mailing Address - Country:US
Mailing Address - Phone:757-220-4917
Mailing Address - Fax:757-220-5884
Practice Address - Street 1:1139 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3329
Practice Address - Country:US
Practice Address - Phone:757-220-4917
Practice Address - Fax:757-220-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1025361OtherAMERICAN SPECIALTY HEALTH
VA5898271OtherGHI
VA7116255OtherMAMSI
VA317460OtherANTHEM BCBS
VA33369OtherSENTARA
VA33369OtherSENTARA