Provider Demographics
NPI:1376594333
Name:WALKER, LANCE WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:WILLIAM
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 1:5204 S REDWOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4217
Mailing Address - Country:US
Mailing Address - Phone:801-417-5700
Mailing Address - Fax:
Practice Address - Street 1:5204 S REDWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-4217
Practice Address - Country:US
Practice Address - Phone:801-417-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52829301202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056378Medicare ID - Type Unspecified
UTU95066Medicare UPIN