Provider Demographics
NPI:1962453415
Name:WALKER, ROGER PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
Last Name:WALKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 E GREENWAY RD
Mailing Address - Street 2:STE. #1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4797
Mailing Address - Country:US
Mailing Address - Phone:602-493-0004
Mailing Address - Fax:
Practice Address - Street 1:4022 E GREENWAY RD
Practice Address - Street 2:STE. #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4797
Practice Address - Country:US
Practice Address - Phone:602-493-0004
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5011111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC5011Medicare UPIN