Provider Demographics
NPI:1649200130
Name:WALKER, JENNIFER E (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 CAROLINA AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1738
Mailing Address - Country:US
Mailing Address - Phone:540-343-0055
Mailing Address - Fax:540-343-0056
Practice Address - Street 1:2110 CAROLINA AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1738
Practice Address - Country:US
Practice Address - Phone:540-343-0055
Practice Address - Fax:540-343-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
188918OtherANTHEM
P00319591OtherMEDICARE RR
188918OtherANTHEM
U90215Medicare UPIN