Provider Demographics
NPI:1063513968
Name:WALSH, BARRY F (DC)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:F
Last Name:WALSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15R HARTFORD AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2308
Mailing Address - Country:US
Mailing Address - Phone:860-844-0444
Mailing Address - Fax:860-844-8525
Practice Address - Street 1:15R HARTFORD AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2308
Practice Address - Country:US
Practice Address - Phone:860-844-0444
Practice Address - Fax:860-844-8525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 000695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000695CT07OtherANTHEM BCBS
3095662OtherAETNA
3095662OtherAETNA
U38404Medicare UPIN