Provider Demographics
NPI:1184839383
Name:WALCHER, KEVIN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAY
Last Name:WALCHER
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:PO BOX 350
Mailing Address - Street 2:105 HWY, 15 WEST
Mailing Address - City:BOOKER
Mailing Address - State:TX
Mailing Address - Zip Code:79005-0350
Mailing Address - Country:US
Mailing Address - Phone:806-658-9882
Mailing Address - Fax:806-658-4780
Practice Address - Street 1:105 HWY. 15 WEST
Practice Address - Street 2:
Practice Address - City:BOOKER
Practice Address - State:TX
Practice Address - Zip Code:79005-0350
Practice Address - Country:US
Practice Address - Phone:806-658-9882
Practice Address - Fax:806-658-4780
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU09757Medicare UPIN