Provider Demographics
NPI:1255586160
Name:WALDER, JENNIFER B (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:WALDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BEISER BLVD
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8208
Mailing Address - Country:US
Mailing Address - Phone:302-734-0300
Mailing Address - Fax:302-734-9300
Practice Address - Street 1:240 BEISER BLVD
Practice Address - Street 2:SUITE 202A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8208
Practice Address - Country:US
Practice Address - Phone:302-734-0300
Practice Address - Fax:302-734-9300
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor