Provider Demographics
NPI:1639357494
Name:WALTON CHIROPRACTIC CENTER, A.P.C.
Entity Type:Organization
Organization Name:WALTON CHIROPRACTIC CENTER, A.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-475-1600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12302302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56437ZOtherBLUE SHIELD PROVIDER
CA=========OtherTAX ID
CADC0123020Medicare UPIN