Provider Demographics
NPI:1043430622
Name:WALKER, BONNIE LUCILE (DC, L AC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LUCILE
Last Name:WALKER
Suffix:
Gender:F
Credentials:DC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 HIGHWAY 105 STE 9
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7802
Mailing Address - Country:US
Mailing Address - Phone:828-265-0001
Mailing Address - Fax:828-265-0117
Practice Address - Street 1:2348 HIGHWAY 105 STE 9
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7802
Practice Address - Country:US
Practice Address - Phone:828-265-0001
Practice Address - Fax:828-265-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2340599Medicare ID - Type Unspecified