Provider Demographics
NPI:1639666357
Name:SMITH, WALTER EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:EDWARD
Last Name:SMITH
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 1:4802 LAKEVIEW PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4041
Mailing Address - Country:US
Mailing Address - Phone:404-398-5827
Mailing Address - Fax:
Practice Address - Street 1:4802 LAKEVIEW PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4041
Practice Address - Country:US
Practice Address - Phone:404-398-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1833111N00000X
TX14069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor