Provider Demographics
NPI:1770653768
Name:WALLS, BUEL M (DC)
Entity Type:Individual
Prefix:DR
First Name:BUEL
Middle Name:M
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 1:800 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4345
Mailing Address - Country:US
Mailing Address - Phone:580-223-2835
Mailing Address - Fax:580-223-6050
Practice Address - Street 1:800 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4345
Practice Address - Country:US
Practice Address - Phone:580-223-2835
Practice Address - Fax:580-223-6050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor