Provider Demographics
NPI:1083802417
Name:WALKER, JESSICA AMBER (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:AMBER
Last Name:WALKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 S COAST HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5058
Mailing Address - Country:US
Mailing Address - Phone:760-967-7444
Mailing Address - Fax:760-967-7445
Practice Address - Street 1:1012 S COAST HWY
Practice Address - Street 2:SUITE G
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5058
Practice Address - Country:US
Practice Address - Phone:760-967-7444
Practice Address - Fax:760-967-7445
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2657111N00000X
CADC 30518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADZ418ZMedicare UPIN