Provider Demographics
NPI:1013215102
Name:SCOTT, WALKER WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:WALKER
Middle Name:WALTER
Last Name:SCOTT
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 1:861 HAROLD PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4553
Mailing Address - Country:US
Mailing Address - Phone:619-796-6472
Mailing Address - Fax:619-342-7577
Practice Address - Street 1:861 HAROLD PL
Practice Address - Street 2:SUITE 210
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4553
Practice Address - Country:US
Practice Address - Phone:619-796-6472
Practice Address - Fax:619-342-7577
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFU862ZMedicare UPIN