Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1100326 | MI |
NPI | 1003032442 |
---|---|
Provider Name | Dr. Michaella J Walter |
First Address | Royal Oak, MI 48073-3300 |
Second Address | Birmingham, MI 48009-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 28/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OP56370 | MEDICARE PTAN (01) | MI |