Provider Demographics
NPI:1053447003
Name:WALSH, ROBERT HAROLD JR
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HAROLD
Last Name:WALSH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LEROY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-1246
Mailing Address - Country:US
Mailing Address - Phone:815-626-7220
Mailing Address - Fax:
Practice Address - Street 1:108 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-1246
Practice Address - Country:US
Practice Address - Phone:815-626-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL778120Medicare ID - Type UnspecifiedPROVIDER NO.