Provider Demographics
NPI:1235259714
Name:WALTERS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:WALTERS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-259-8056
Mailing Address - Street 1:121 W KING ST
Mailing Address - Street 2:PO BOX 763
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9728
Mailing Address - Country:US
Mailing Address - Phone:717-259-8056
Mailing Address - Fax:717-259-6774
Practice Address - Street 1:121 W KING ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9728
Practice Address - Country:US
Practice Address - Phone:717-259-8056
Practice Address - Fax:717-259-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006278L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2226775OtherAETNA
PAWA761669OtherBLUE CROSS BLUE SHIELD
PA03086800OtherCAPITAL BLUE CROSS
PA0652142000OtherINDEPENDENCE BLUE CROSS B
PA2226775OtherUS HEALTH CARE
PA273643OtherMAMSI
PA8661359001OtherCIGNA
PAWA761669OtherHIGHMARK
PA5990505OtherAETNA
PA03086800OtherKEYSTONE HEALTH PLAN CENT
PA0652142000OtherINDEPENDENCE BLUE CROSS B
PA2226775OtherAETNA
PA273643OtherMAMSI
PAU61397Medicare UPIN
PA03086800OtherKEYSTONE HEALTH PLAN CENT