Provider Demographics
NPI:1023433935
Name:WALSH, WILLIAM JOHN (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:WALSH
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 1:72 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3986
Mailing Address - Country:US
Mailing Address - Phone:732-662-9901
Mailing Address - Fax:732-662-9904
Practice Address - Street 1:72 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3986
Practice Address - Country:US
Practice Address - Phone:732-662-9901
Practice Address - Fax:732-662-9904
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11136111N00000X
NJ38MC00730700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor