Provider Demographics
NPI:1699894030
Name:WALTERS, MARK EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EUGENE
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 1:19523 222ND ST
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-4460
Mailing Address - Country:US
Mailing Address - Phone:913-909-3559
Mailing Address - Fax:
Practice Address - Street 1:3115 W 6TH ST
Practice Address - Street 2:SUITE K
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3101
Practice Address - Country:US
Practice Address - Phone:913-909-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor