Provider Demographics
NPI:1235135393
Name:WALTON, PAUL DWIGHT (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DWIGHT
Last Name:WALTON
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 1:50 VASHELL WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3020
Mailing Address - Country:US
Mailing Address - Phone:925-253-9446
Mailing Address - Fax:925-253-9505
Practice Address - Street 1:50 VASHELL WAY
Practice Address - Street 2:STE 300
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3020
Practice Address - Country:US
Practice Address - Phone:925-253-9446
Practice Address - Fax:925-253-9505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16583111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06193Medicare UPIN
CADC0165830Medicare ID - Type Unspecified