Provider Demographics
NPI:1396885653
Name:WALK, ANGELA GAYLE (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:GAYLE
Last Name:WALK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 SPERA POINTE XING
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3699
Mailing Address - Country:US
Mailing Address - Phone:615-478-3038
Mailing Address - Fax:
Practice Address - Street 1:315 DEADERICK ST
Practice Address - Street 2:SUITE 120
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37238-3000
Practice Address - Country:US
Practice Address - Phone:615-255-9469
Practice Address - Fax:615-255-5158
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN648308OtherACN GROUP
TN3081836OtherBLUE CROSS BLUE SHIELD TN
TN53535876OtherAETNA
TN2579585OtherCIGNA