Provider Demographics
NPI:1639385412
Name:WALTERS, CHADWICK A (DO)
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:4400 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4135
Mailing Address - Country:US
Mailing Address - Phone:502-491-9590
Mailing Address - Fax:502-491-9592
Practice Address - Street 1:4400 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 124
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4135
Practice Address - Country:US
Practice Address - Phone:502-491-9590
Practice Address - Fax:502-491-9592
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY03009208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation