Provider Demographics
NPI:1225342710
Name:WALTERS, DANA L (DC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-221-1212
Mailing Address - Fax:516-221-1292
Practice Address - Street 1:2874 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5726
Practice Address - Country:US
Practice Address - Phone:516-221-1212
Practice Address - Fax:516-221-1292
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-05-23
Deactivation Date:2010-06-16
Deactivation Code:
Reactivation Date:2010-07-27
Provider Licenses
StateLicense IDTaxonomies
NYX010239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX0102391Medicare UPIN