Provider Demographics
NPI:1184261109
Name:WALTERS, JAMES D (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:WALTERS
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 1:34 TERRACE VILLAS
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1958
Mailing Address - Country:US
Mailing Address - Phone:585-944-0955
Mailing Address - Fax:
Practice Address - Street 1:1655 ELMWOOD AVE STE 235
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3431
Practice Address - Country:US
Practice Address - Phone:585-444-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor