Provider Demographics
NPI:1801531827
Name:WALTER, MADISYN (DC)
Entity type:Individual
Prefix:DR
First Name:MADISYN
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6679 W 1600 S
Mailing Address - Street 2:
Mailing Address - City:WANATAH
Mailing Address - State:IN
Mailing Address - Zip Code:46390-9758
Mailing Address - Country:US
Mailing Address - Phone:219-851-7767
Mailing Address - Fax:
Practice Address - Street 1:11576 W US HIGHWAY 30 # C
Practice Address - Street 2:
Practice Address - City:WANATAH
Practice Address - State:IN
Practice Address - Zip Code:46390-9300
Practice Address - Country:US
Practice Address - Phone:219-851-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003296A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor