Provider Demographics
NPI:1669518031
Name:WALTHER, BRYAN FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:FREDERICK
Last Name:WALTHER
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 1:1240 STATE ROUTE 28
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150
Mailing Address - Country:US
Mailing Address - Phone:513-575-5444
Mailing Address - Fax:513-575-1819
Practice Address - Street 1:1240 STATE ROUTE 28
Practice Address - Street 2:SUITE B
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4928
Practice Address - Country:US
Practice Address - Phone:513-575-5444
Practice Address - Fax:513-575-1819
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor