Provider Demographics
NPI:1497038640
Name:WALTERS, JUSTIN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-6459
Mailing Address - Country:US
Mailing Address - Phone:913-439-7485
Mailing Address - Fax:
Practice Address - Street 1:1410 N 4TH ST E
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-6459
Practice Address - Country:US
Practice Address - Phone:913-439-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST03149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor