Organization
MARK V. WALTERS DC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK V WALTERS D.C (OWNER/OPERATOR)
(417) 461-1155
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
006467
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315015486
MEDICARE PTAN
MO
01
—
350039075
RAILROAD MEDICARE
MO
Enumeration date
12/08/2011
Last updated
12/08/2011
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