Provider Demographics
NPI:1417000787
Name:WALZ, JOHN FRANCIS (MSOM, LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANCIS
Last Name:WALZ
Suffix:
Gender:M
Credentials:MSOM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:12449 REGENT WAY
Mailing Address - City:BROWNS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95918-0652
Mailing Address - Country:US
Mailing Address - Phone:530-300-0782
Mailing Address - Fax:530-755-3200
Practice Address - Street 1:466 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4125
Practice Address - Country:US
Practice Address - Phone:530-755-3200
Practice Address - Fax:530-755-3205
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11490171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist