Provider Demographics
NPI:1700885670
Name:PRIESTLEY, WALTER F (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:F
Last Name:PRIESTLEY
Suffix:
Gender:M
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CONKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2555
Mailing Address - Country:US
Mailing Address - Phone:516-752-1007
Mailing Address - Fax:516-752-2767
Practice Address - Street 1:81 CONKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2555
Practice Address - Country:US
Practice Address - Phone:516-752-1007
Practice Address - Fax:516-752-2767
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005258-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX005258-1OtherLICENSE NUMBER
NYX35151Medicare ID - Type UnspecifiedPROVIDER ID