Provider Demographics
NPI: | 1508282963 |
---|---|
Name: | VENESSA E. WALKER, DC PA |
Entity Type: | Organization |
Organization Name: | VENESSA E. WALKER, DC PA |
Other - Org Name: | WALKER CHIROPRACTIC AND WELLNESS CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | VENESSA |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | WALKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 954-701-9529 |
Mailing Address - Street 1: | 8844 MIRAMAR PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | MIRAMAR |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33025-2732 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8844 MIRAMAR PKWY |
Practice Address - Street 2: | |
Practice Address - City: | MIRAMAR |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33025-2732 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-701-9529 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-10 |
Last Update Date: | 2014-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | CH1056 | 305R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 305R00000X | Managed Care Organizations | Preferred Provider Organization |