Provider Demographics
NPI:1861567364
Name:WALSH, ROBERT EMMETT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMMETT
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 1:416 SE 11TH COURT
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-525-2225
Mailing Address - Fax:954-525-1807
Practice Address - Street 1:416 SE 11TH COURT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-525-2225
Practice Address - Fax:954-525-1807
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050115800Medicaid
FL050115800Medicaid
T85443Medicare UPIN