Provider Demographics
NPI:1639235492
Name:WALTON, HARRY (DC)
Entity Type:Individual
Prefix:
First Name:HARRY
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 1:3811 PORTOLA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5232
Mailing Address - Country:US
Mailing Address - Phone:831-475-1600
Mailing Address - Fax:831-475-1122
Practice Address - Street 1:3811 PORTOLA DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-5232
Practice Address - Country:US
Practice Address - Phone:831-475-1600
Practice Address - Fax:831-475-1122
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56437ZOtherBLUE SHIELD PROVIDER
CADC0123020Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER