Provider Demographics
NPI:1750643433
Name:WALTERS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WALTERS CHIROPRACTIC, LLC
Other - Org Name:WALTERS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-738-7667
Mailing Address - Street 1:2011 E CROSSROADS LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1674
Mailing Address - Country:US
Mailing Address - Phone:913-738-7667
Mailing Address - Fax:
Practice Address - Street 1:2011 E CROSSROADS LN
Practice Address - Street 2:SUITE 302
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1674
Practice Address - Country:US
Practice Address - Phone:913-738-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST03149261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service