Provider Demographics
NPI:1679718571
Name:WALKER, CHARLES T (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
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 1:250 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6817
Mailing Address - Country:US
Mailing Address - Phone:701-293-8882
Mailing Address - Fax:701-293-8854
Practice Address - Street 1:250 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6817
Practice Address - Country:US
Practice Address - Phone:701-293-8882
Practice Address - Fax:701-293-8854
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24925Medicare PIN