Provider Demographics
NPI:1376621649
Name:WALKER, BRAD L (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:L
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:PO BOX 8023
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-0023
Mailing Address - Country:US
Mailing Address - Phone:409-755-7246
Mailing Address - Fax:409-755-7629
Practice Address - Street 1:837 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7358
Practice Address - Country:US
Practice Address - Phone:409-755-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5247721OtherAETNA
TX8B0950OtherBCBS
TX42076300OtherCIGNA
TX8B0950OtherBCBS
TXU73742Medicare UPIN
TX42076300OtherCIGNA