Provider Demographics
NPI:1992076053
Name:WALSH, MIKI (RMT, CNMT)
Entity type:Individual
Prefix:
First Name:MIKI
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8842 N UNION BLVD
Mailing Address - Street 2:AMSDEN CHIROPRACTIC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7798
Mailing Address - Country:US
Mailing Address - Phone:719-494-2088
Mailing Address - Fax:719-282-6464
Practice Address - Street 1:8842 N UNION BLVD
Practice Address - Street 2:AMSDEN CHIROPRACTIC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7798
Practice Address - Country:US
Practice Address - Phone:719-494-2088
Practice Address - Fax:719-282-6464
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist