Provider Demographics
NPI:1497838304
Name:WALSH CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:WALSH CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-629-6500
Mailing Address - Street 1:1537 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2795
Mailing Address - Country:US
Mailing Address - Phone:810-629-6500
Mailing Address - Fax:810-629-6616
Practice Address - Street 1:1537 N LEROY
Practice Address - Street 2:SUITE F
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2795
Practice Address - Country:US
Practice Address - Phone:810-629-6500
Practice Address - Fax:810-629-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P25280Medicare PIN