Provider Demographics
NPI:1427447127
Name:WALTERS, MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:WALTERS
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:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-1747
Mailing Address - Country:US
Mailing Address - Phone:904-887-4708
Mailing Address - Fax:
Practice Address - Street 1:10910 STATE ROAD 70 E STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8406
Practice Address - Country:US
Practice Address - Phone:941-799-7207
Practice Address - Fax:941-799-2077
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor