Provider Demographics
NPI:1720205685
Name:WALSH, BRIAN FRANCIS (MA, DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:WALSH
Suffix:
Gender:M
Credentials:MA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-1932
Mailing Address - Country:US
Mailing Address - Phone:417-847-8714
Mailing Address - Fax:
Practice Address - Street 1:1413 CHERRY ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-1932
Practice Address - Country:US
Practice Address - Phone:417-847-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCEO 4965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1303629OtherTIN