Provider Demographics
NPI:1801903422
Name:BOND, WALTER DAVID (DC, QME)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DAVID
Last Name:BOND
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17525 VENTURA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5111
Mailing Address - Country:US
Mailing Address - Phone:818-501-8743
Mailing Address - Fax:818-501-1083
Practice Address - Street 1:17525 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5111
Practice Address - Country:US
Practice Address - Phone:818-501-8743
Practice Address - Fax:818-501-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52267Medicare UPIN