Provider Demographics
NPI:1578625752
Name:WALTON, THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:WALTON
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 1:320 ULUNIU ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2529
Mailing Address - Country:US
Mailing Address - Phone:808-261-8181
Mailing Address - Fax:808-261-7770
Practice Address - Street 1:320 ULUNIU ST
Practice Address - Street 2:SUITE 2
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2529
Practice Address - Country:US
Practice Address - Phone:808-261-8181
Practice Address - Fax:808-261-7770
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC 450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIT06576Medicare UPIN