Provider Demographics
NPI:1154454650
Name:WALKER, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:WALKER
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 1:113 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1149
Mailing Address - Country:US
Mailing Address - Phone:270-259-9890
Mailing Address - Fax:270-259-0538
Practice Address - Street 1:113 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1149
Practice Address - Country:US
Practice Address - Phone:270-259-9890
Practice Address - Fax:279-259-0538
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001964Medicaid
KYBCBS-000000069047OtherBLUE CROSS BLUE SHIELD
KY85001964Medicaid
KYBCBS-000000069047OtherBLUE CROSS BLUE SHIELD