Provider Demographics
NPI:1942272042
Name:WALKER, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:HIBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7901 N OWASSO EXPY
Mailing Address - Street 2:STE. 1
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3333
Mailing Address - Country:US
Mailing Address - Phone:918-272-9553
Mailing Address - Fax:918-272-5358
Practice Address - Street 1:7901 N OWASSO EXPY
Practice Address - Street 2:STE. 1
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3333
Practice Address - Country:US
Practice Address - Phone:918-272-9553
Practice Address - Fax:918-272-5358
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU69210Medicare UPIN