Provider Demographics
NPI:1922058601
Name:WALKER FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WALKER FAMILY CHIROPRACTIC, PC
Other - Org Name:WALKER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-467-5858
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008621-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000122Medicare PIN