Provider Demographics
NPI:1598765836
Name:WALBURN, GEOFFREY JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:JACOB
Last Name:WALBURN
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 1:401 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3513
Mailing Address - Country:US
Mailing Address - Phone:812-273-4325
Mailing Address - Fax:812-273-9275
Practice Address - Street 1:401 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3513
Practice Address - Country:US
Practice Address - Phone:812-273-4325
Practice Address - Fax:812-273-9275
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001724A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00094455OtherRAILROAD MEDICARE
5840636OtherAETNA INSURANCE COMPANY
000000321777OtherANTHEM BLUE CROSS/SHIELD
041352OtherSIHO
IN224320AMedicare ID - Type Unspecified
5840636OtherAETNA INSURANCE COMPANY