Provider Demographics
NPI:1720596497
Name:WALSH, KARISA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KARISA
Middle Name:LYNN
Last Name:WALSH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KARISA
Other - Middle Name:LYNN
Other - Last Name:KURSZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8085 WAYZATA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8085 WAYZATA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1457
Practice Address - Country:US
Practice Address - Phone:763-710-7427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor