Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 16583 | CA |
NPI | 1235135393 |
---|---|
Provider Name | Paul Dwight Walton |
First Address | Orinda, CA 94563-3020 |
Second Address | Orinda, CA 94563-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T06193 | (02) | CA |