Provider Demographics
NPI:1578822565
Name:WALTERS, KACIE ESTES (DC)
Entity Type:Individual
Prefix:DR
First Name:KACIE
Middle Name:ESTES
Last Name:WALTERS
Suffix:
Gender:F
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:S71W23325 NATIONAL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9495
Mailing Address - Country:US
Mailing Address - Phone:262-662-9775
Mailing Address - Fax:262-662-9773
Practice Address - Street 1:1120 JAMES DR STE B
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029
Practice Address - Country:US
Practice Address - Phone:262-662-9775
Practice Address - Fax:262-662-9773
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor