Provider Demographics
NPI:1891983441
Name:WALNUT GROUP MANAGEMENT
Entity Type:Organization
Organization Name:WALNUT GROUP MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:ALSEN
Authorized Official - Last Name:REUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-963-7432
Mailing Address - Street 1:1502 NORTH PINE ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-963-7432
Mailing Address - Fax:541-963-0597
Practice Address - Street 1:1502 NORTH PINE ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-963-7432
Practice Address - Fax:541-963-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR651161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR173668502619OtherWORKER'S COMP
OR196972Medicaid
WA196671OtherWORKER'S COMP
ORR0000QCBKFMedicare PIN
ORT68050Medicare UPIN