Provider Demographics
NPI:1760401491
Name:WALSH, JAMES LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:WALSH
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 1:1701 NE 42ND AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8022
Mailing Address - Country:US
Mailing Address - Phone:352-671-3100
Mailing Address - Fax:352-236-0815
Practice Address - Street 1:1701 NE 42ND AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8022
Practice Address - Country:US
Practice Address - Phone:352-671-3100
Practice Address - Fax:352-236-0815
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70552OtherBLUE CROSSBLUE SHIELD
FLT94432Medicare UPIN
FL70552OtherBLUE CROSSBLUE SHIELD