Provider Demographics
NPI:1841390689
Name:WALSH, DANIEL PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
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 1:544 S MAIN ST ROUTE 11
Mailing Address - Street 2:P.O. BOX 893
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-9502
Mailing Address - Country:US
Mailing Address - Phone:315-668-3248
Mailing Address - Fax:315-676-3796
Practice Address - Street 1:544 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-9779
Practice Address - Country:US
Practice Address - Phone:315-668-3248
Practice Address - Fax:315-676-3796
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010102-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5323798OtherCIGNA
NY010110102OtherBCBS
NYNY10102OtherLANDMARK
NY7455427OtherAETNA
NY161609946OtherPOMCO
NY5897918OtherGHI
NY02421612Medicaid
NY10054140OtherCDPHP
NYNY10102OtherTOTAL CARE
NYX010102OtherALL NO FAULT
NYC10102-4BOtherALL WORKERS COMPENSATION
NYP-11213126OtherMULTIPLAN
NYX010102OtherRMSCO
NY5897918OtherGHI
NYX010102OtherRMSCO