Provider Demographics
NPI:1376199323
Name:WALTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WALTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-255-6434
Mailing Address - Street 1:1230 PRAIRIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-8733
Mailing Address - Country:US
Mailing Address - Phone:701-255-6434
Mailing Address - Fax:
Practice Address - Street 1:1655 N GRANDVIEW LN STE 204
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0877
Practice Address - Country:US
Practice Address - Phone:701-255-6434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty