Provider Demographics
NPI:1477665701
Name:WALTERS, CAROL JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:WALTERS
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 1:315 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003
Mailing Address - Country:US
Mailing Address - Phone:507-385-2000
Mailing Address - Fax:507-385-1933
Practice Address - Street 1:1712 JAMES DR
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-1804
Practice Address - Country:US
Practice Address - Phone:507-385-2000
Practice Address - Fax:507-385-1933
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3284111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN406223000Medicaid
MN406223000Medicaid
MN350003273Medicare ID - Type Unspecified