Provider Demographics
NPI:1609169358
Name:CLIFF WALKER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CLIFF WALKER CHIROPRACTIC, PC
Other - Org Name:WALKER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:979-846-2969
Mailing Address - Street 1:4001 E 29TH ST
Mailing Address - Street 2:STE 108
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4226
Mailing Address - Country:US
Mailing Address - Phone:979-846-2969
Mailing Address - Fax:979-846-2965
Practice Address - Street 1:4001 E 29TH ST
Practice Address - Street 2:STE 108
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4226
Practice Address - Country:US
Practice Address - Phone:979-846-2969
Practice Address - Fax:979-846-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132230Medicare PIN