Provider Demographics
NPI:1326218934
Name:WALSH CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:WALSH CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-422-0622
Mailing Address - Street 1:800 AIRPORT RD
Mailing Address - Street 2:STE 103
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-6421
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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU01969Medicare UPIN