Provider Demographics
NPI:1457349169
Name:WALLEY, ERIK JAMES (DC)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:JAMES
Last Name:WALLEY
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 1:1707 PATTENGILL AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1112
Mailing Address - Country:US
Mailing Address - Phone:517-449-0867
Mailing Address - Fax:
Practice Address - Street 1:2600 EATON RAPIDS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6309
Practice Address - Country:US
Practice Address - Phone:517-699-0909
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor