Provider Demographics
NPI:1750399689
Name:WALCHER, KELLI JO (DC)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:JO
Last Name:WALCHER
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 1:1925 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1000
Mailing Address - Country:US
Mailing Address - Phone:408-379-4240
Mailing Address - Fax:408-379-4270
Practice Address - Street 1:1925 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1000
Practice Address - Country:US
Practice Address - Phone:408-379-4240
Practice Address - Fax:408-379-4270
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
26164Medicare UPIN
CADC0261640Medicare ID - Type Unspecified