Provider Demographics
NPI:1407947567
Name:WALKER, JODY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ALLEN
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 1:3001 S COLUMBIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6064
Mailing Address - Country:US
Mailing Address - Phone:701-795-8818
Mailing Address - Fax:701-795-4888
Practice Address - Street 1:3001 S COLUMBIA RD STE C
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6064
Practice Address - Country:US
Practice Address - Phone:701-795-8818
Practice Address - Fax:701-795-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10713Medicaid
ND10713Medicaid
20226Medicare ID - Type Unspecified