Provider Demographics
NPI:1760097208
Name:WALKER, JONATHAN ELI (L AC MS TCM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ELI
Last Name:WALKER
Suffix:
Gender:M
Credentials:L AC MS TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4111
Mailing Address - Country:US
Mailing Address - Phone:919-949-2676
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 6004
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2539
Practice Address - Country:US
Practice Address - Phone:919-949-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty