Provider Demographics
NPI:1508883505
Name:WALOU INC.
Entity Type:Organization
Organization Name:WALOU INC.
Other - Org Name:BEDFORD COUNTY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:FAUSNAUGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:931-685-0040
Mailing Address - Street 1:2937 PELLAS PL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6954
Mailing Address - Country:US
Mailing Address - Phone:931-685-0040
Mailing Address - Fax:931-685-0045
Practice Address - Street 1:1509 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2323
Practice Address - Country:US
Practice Address - Phone:931-685-0040
Practice Address - Fax:931-685-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36714342Medicare Oscar/Certification