Provider Demographics
NPI:1437385440
Name:WALSH CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:WALSH CHIROPRACTIC, PLLC
Other - Org Name:LEEPER CHIROPRACTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-554-9637
Mailing Address - Street 1:229 S FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5702
Mailing Address - Country:US
Mailing Address - Phone:270-554-9637
Mailing Address - Fax:270-554-5337
Practice Address - Street 1:229 S FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5702
Practice Address - Country:US
Practice Address - Phone:270-554-9637
Practice Address - Fax:270-554-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5188111N00000X
KY5187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty