Provider Demographics
NPI:1619035300
Name:WALTERS, TODD B (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:B
Last Name:WALTERS
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 1:1619 VICTOR RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7883
Mailing Address - Country:US
Mailing Address - Phone:740-653-5390
Mailing Address - Fax:740-653-2808
Practice Address - Street 1:1619 VICTOR RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-653-5390
Practice Address - Fax:740-653-2808
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1714111N00000X
IN08001286111N00000X
KY4112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188103Medicaid
WA0792316Medicare ID - Type Unspecified
OH0188103Medicaid