Provider Demographics
NPI:1679809396
Name:WALTERS, LOU (ND)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 W STEVENS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7043
Mailing Address - Country:US
Mailing Address - Phone:406-556-0307
Mailing Address - Fax:406-556-0310
Practice Address - Street 1:1924 W STEVENS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7043
Practice Address - Country:US
Practice Address - Phone:406-556-0307
Practice Address - Fax:406-556-0310
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT122175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath