Provider Demographics
NPI:1508993437
Name:WALSH, PATRICK JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:WALSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 COMMERCE BLVD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2179
Mailing Address - Country:US
Mailing Address - Phone:707-584-5678
Mailing Address - Fax:707-584-7020
Practice Address - Street 1:6020 COMMERCE BLVD
Practice Address - Street 2:SUITE 128
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2179
Practice Address - Country:US
Practice Address - Phone:707-584-5678
Practice Address - Fax:707-584-7020
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0165820Medicare ID - Type Unspecified