Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3284 | MN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 3284 | MN |
NPI | 1477665701 |
---|---|
Provider Name | Dr. Carol Jean Walters |
First Address | North Mankato, MN 56003 |
Second Address | North Mankato, MN 56003-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
406223000 | (05) | MN |
U58390 | (02) | MN |