Provider Demographics
NPI:1013113711
Name:WALDEN, MARYBELLE (CHIROPRACTOR DC)
Entity Type:Individual
Prefix:
First Name:MARYBELLE
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:CHIROPRACTOR DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N. MAIN ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762
Mailing Address - Country:US
Mailing Address - Phone:423-372-0000
Mailing Address - Fax:423-372-0000
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2136
Practice Address - Country:US
Practice Address - Phone:423-372-0000
Practice Address - Fax:423-372-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2181111N00000X
KY5048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor