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Individual

DR. MARK VINCENT WALTERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

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
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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