Provider Demographics
NPI:1558464545
Name:HARVEY W WALLER DC INC
Entity type:Organization
Organization Name:HARVEY W WALLER DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF HARVEY W WALLER DC INC
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-266-2227
Mailing Address - Street 1:4220 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3618
Mailing Address - Country:US
Mailing Address - Phone:740-266-2227
Mailing Address - Fax:740-266-2421
Practice Address - Street 1:4220 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3618
Practice Address - Country:US
Practice Address - Phone:740-266-2227
Practice Address - Fax:740-266-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098782Medicaid
OH0390811Medicare PIN
OH0098782Medicaid