Provider Demographics
NPI:1356649230
Name:RICHARD D.WALFORD, DC, PC
Entity Type:Organization
Organization Name:RICHARD D.WALFORD, DC, PC
Other - Org Name:WALFORD CHIROPRACTIC OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-632-4225
Mailing Address - Street 1:1410 S. 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4204
Mailing Address - Country:US
Mailing Address - Phone:719-632-4225
Mailing Address - Fax:719-632-3732
Practice Address - Street 1:1410 S. 21ST STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4204
Practice Address - Country:US
Practice Address - Phone:719-632-4225
Practice Address - Fax:719-632-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
18763Medicare UPIN