Provider Demographics
NPI:1174722672
Name:WALSH, DIANA PATRICIA (DC)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:PATRICIA
Last Name:WALSH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GRANT ST
Mailing Address - Street 2:2-C
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2940
Mailing Address - Country:US
Mailing Address - Phone:707-746-1315
Mailing Address - Fax:
Practice Address - Street 1:1060 GRANT ST
Practice Address - Street 2:2-C
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2940
Practice Address - Country:US
Practice Address - Phone:707-746-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0181670Medicare UPIN