Provider Demographics
NPI:1700960135
Name:WALSH, DANIEL PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PETER
Last Name:WALSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9633 MARKET PL UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7944
Mailing Address - Country:US
Mailing Address - Phone:425-335-0300
Mailing Address - Fax:425-335-0302
Practice Address - Street 1:9633 MARKET PL UNIT 103
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7944
Practice Address - Country:US
Practice Address - Phone:425-335-0300
Practice Address - Fax:425-335-0302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH33919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873022Medicare PIN