Provider Demographics
NPI:1750693610
Name:WALTER, PATRICK JOSEPH (DC, MS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:WALTER
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BAY ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1104
Mailing Address - Country:US
Mailing Address - Phone:510-867-7943
Mailing Address - Fax:
Practice Address - Street 1:2648 INTERNATIONAL BLVD STE 701
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1506
Practice Address - Country:US
Practice Address - Phone:510-867-7943
Practice Address - Fax:510-952-8265
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15422111N00000X, 111NN1001X, 111NR0400X, 111NT0100X, 111NX0100X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NT0100XChiropractic ProvidersChiropractorThermography
No111NX0100XChiropractic ProvidersChiropractorOccupational Health