Provider Demographics
NPI:1912037243
Name:WALKER, LES A (DC)
Entity Type:Individual
Prefix:
First Name:LES
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:A
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:137 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:DEPOSIT
Mailing Address - State:NY
Mailing Address - Zip Code:13754-1128
Mailing Address - Country:US
Mailing Address - Phone:607-467-5858
Mailing Address - Fax:607-467-5655
Practice Address - Street 1:137 FRONT ST
Practice Address - Street 2:
Practice Address - City:DEPOSIT
Practice Address - State:NY
Practice Address - Zip Code:13754-1128
Practice Address - Country:US
Practice Address - Phone:607-467-5858
Practice Address - Fax:607-467-5655
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11124869OtherCAQH
NYJ400002012Medicare PIN