Provider Demographics
NPI:1124207691
Name:CULPEPPER, WALTER ALLEN (D C)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ALLEN
Last Name:CULPEPPER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VILLA ROSA RD
Mailing Address - Street 2:SUITE 5-E
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-5607
Mailing Address - Country:US
Mailing Address - Phone:770-562-8590
Mailing Address - Fax:770-562-8591
Practice Address - Street 1:40 VILLA ROSA RD
Practice Address - Street 2:SUITE 5-E
Practice Address - City:TEMPLE
Practice Address - State:GA
Practice Address - Zip Code:30179-5607
Practice Address - Country:US
Practice Address - Phone:770-562-8590
Practice Address - Fax:770-562-8591
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1055111N00000X
FL6900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor