Provider Demographics
NPI:1114079456
Name:WALSH, AARON MATHEW (DC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MATHEW
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 1:92 1/2 HIGH ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3130
Mailing Address - Country:US
Mailing Address - Phone:978-744-9708
Mailing Address - Fax:978-774-6020
Practice Address - Street 1:92 1/2 HIGH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3130
Practice Address - Country:US
Practice Address - Phone:978-744-9708
Practice Address - Fax:978-774-6020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36921OtherBLUE CROSS BLUE SHIELD
MAY45586Medicare ID - Type Unspecified
MAY36921OtherBLUE CROSS BLUE SHIELD