Provider Demographics
NPI:1831296797
Name:WALKER, RICHARD W (D C)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:WALKER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2549
Mailing Address - Country:US
Mailing Address - Phone:662-773-3181
Mailing Address - Fax:662-773-4433
Practice Address - Street 1:405 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2549
Practice Address - Country:US
Practice Address - Phone:662-773-3181
Practice Address - Fax:662-773-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST20966Medicare UPIN