Provider Demographics
NPI:1154684785
Name:CHAD WALTERS,DO, LLC
Entity type:Organization
Organization Name:CHAD WALTERS,DO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIRNHELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-491-9590
Mailing Address - Street 1:4400 BRECKENRIDGE LN
Mailing Address - Street 2:STE 124
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4135
Mailing Address - Country:US
Mailing Address - Phone:502-491-9590
Mailing Address - Fax:502-491-9592
Practice Address - Street 1:4400 BRECKENRIDGE LN
Practice Address - Street 2:STE 124
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4135
Practice Address - Country:US
Practice Address - Phone:502-491-9590
Practice Address - Fax:502-491-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03009174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty