Provider Demographics
NPI:1417914425
Name:TUMLINSON, WALTER E (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:TUMLINSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8241
Mailing Address - Country:US
Mailing Address - Phone:517-783-2833
Mailing Address - Fax:517-783-2834
Practice Address - Street 1:4821 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8241
Practice Address - Country:US
Practice Address - Phone:517-783-2833
Practice Address - Fax:517-783-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C85006OtherBCBS
MI2673690Medicaid
MI350025358OtherPALMETTO
MI0C85006Medicare ID - Type Unspecified
MI2673690Medicaid