Provider Demographics
NPI:1407197494
Name:WALTON, MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WALTON
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 1:17000 E 40 HWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5455
Mailing Address - Country:US
Mailing Address - Phone:816-373-6363
Mailing Address - Fax:816-373-6386
Practice Address - Street 1:17000 E 40 HWY
Practice Address - Street 2:SUITE 7
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5455
Practice Address - Country:US
Practice Address - Phone:816-373-6363
Practice Address - Fax:816-373-6386
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor