Provider Demographics
NPI:1902539547
Name:WALTERS, MASON RUSHTON (DC)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:RUSHTON
Last Name:WALTERS
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 1:423 WEATHERSBY RD STE 120B
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1140
Mailing Address - Country:US
Mailing Address - Phone:601-255-5512
Mailing Address - Fax:
Practice Address - Street 1:423 WEATHERSBY RD STE 120B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1140
Practice Address - Country:US
Practice Address - Phone:601-255-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13882111N00000X
MS1357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor