Provider Demographics
NPI:1689760084
Name:WALTER, CODY RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:RAY
Last Name:WALTER
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:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:52209-0267
Mailing Address - Country:US
Mailing Address - Phone:319-454-6455
Mailing Address - Fax:319-454-0091
Practice Address - Street 1:105 1/2 LOCUST ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLAIRSTOWN
Practice Address - State:IA
Practice Address - Zip Code:52209
Practice Address - Country:US
Practice Address - Phone:319-454-6455
Practice Address - Fax:319-454-0091
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0241828Medicaid
IA43744OtherWELLMARK
IA350052834OtherRAILROAD MEDICARE
IA208928197OtherUNITED HEALTHCARE
IA239591OtherMIDLAND'S CHOICE