Provider Demographics
NPI:1770824310
Name:WALKER, MICHEAL ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:ALLEN
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 1:351 COFFMAN ST
Mailing Address - Street 2:STE 120
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5457
Mailing Address - Country:US
Mailing Address - Phone:303-772-3100
Mailing Address - Fax:720-684-4928
Practice Address - Street 1:351 COFFMAN ST
Practice Address - Street 2:STE 120
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5457
Practice Address - Country:US
Practice Address - Phone:303-772-3100
Practice Address - Fax:720-684-4928
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor