Provider Demographics
NPI:1811982036
Name:BURT, WALTER MCARTHUR (DC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:MCARTHUR
Last Name:BURT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:208 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1538
Practice Address - Country:US
Practice Address - Phone:706-234-8221
Practice Address - Fax:706-291-9647
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003115369AMedicaid
GA003115369AMedicaid
GAU81718Medicare UPIN