Provider Demographics
NPI:1376151233
Name:WALTHER, DENISE I (DC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:I
Last Name:WALTHER
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 1:4163 WAIPUA ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5334
Mailing Address - Country:US
Mailing Address - Phone:808-634-0450
Mailing Address - Fax:
Practice Address - Street 1:4163 WAIPUA ST
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5334
Practice Address - Country:US
Practice Address - Phone:808-634-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor