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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