Provider Demographics
NPI:1659449874
Name:WALLS, COURTNEY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:DANIEL
Last Name:WALLS
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 1:51633 US HIGHWAY 69 N
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-5546
Mailing Address - Country:US
Mailing Address - Phone:903-894-3176
Mailing Address - Fax:
Practice Address - Street 1:51633 US HIGHWAY 69 N
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757-5546
Practice Address - Country:US
Practice Address - Phone:903-894-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27-1969833OtherTAX ID
TX612024Medicare ID - Type Unspecified
TX27-1969833OtherTAX ID