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Organization
LONNIE R. WALTERS, DC, PC
Active
Organization
LONNIE R. WALTERS, DC, PC
Active
Other names
Walters Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LONNIE RICHARD WALTERS DC (PRESIDENT)
(417) 258-2863
Entity
Organization
Contact information
Practice address
316 W MOUNT VERNON BLVD, MOUNT VERNON, MO 65712-1940
(417) 461-1155
(417) 461-1155
Mailing address
316 W MOUNT VERNON BLVD, MOUNT VERNON, MO 65712-1940
(417) 461-1155
(417) 461-1155
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
171100000X
Acupuncturist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015486
MEDICARE GROUP PTAN
MO
01
—
304495486
GROUP MEMBER PTAN
MO
Enumeration date
09/27/2007
Last updated
11/23/2011
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