Individual
BLAKE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
701 ASH ST, BARABOO, WI 53913-2139
(608) 844-2116
Mailing address
1875 W PINE ST APT 302, BARABOO, WI 53913-9658
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5284-12
WI
Other
Enumeration date
07/13/2017
Last updated
07/13/2017
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