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Individual
DR. MARK VINCENT WALTERS
Active
Individual
DR. MARK VINCENT WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
006467
MO
171100000X
Acupuncturist
006467
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315015486
INDIVIDUAL PTAN
MO
01
—
350039075
RAILROAD MEDICARE
MO
01
—
990001294
MEDICARE GROUP LEGACY
MO
Enumeration date
12/11/2006
Last updated
08/08/2013
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