MEDICARE: LANCE WILLIAM WALKER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	52829301202	UT

General Provider Information

NPI Number	:	1376594333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE WILLIAM WALKER D.C.

Provider Business Mailing Address
First Line	:	5204 S REDWOOD RD
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-4217
Country	:	US
Telephone Number	:	801-417-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5204 S REDWOOD RD
Second Line	:	SUITE B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-4217
Country	:	US
Telephone Number	:	801-417-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	06/25/2008

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