MEDICARE: WALKER CHIROPRACTIC LIFE CENTER, P.A.

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	C4256	ID

General Provider Information

NPI Number	:	1962672071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALKER CHIROPRACTIC LIFE CENTER, P.A.

Provider Business Mailing Address
First Line	:	10451 W GARVERDALE CT
Second Line	:	SUITE 201
City	:	BOISE
State	:	ID
Zip	:	83704-5408
Country	:	US
Telephone Number	:	208-322-4114
Fax Number	:	208-322-4115

Provider Business Practice Location Address
First Line	:	10451 W GARVERDALE CT
Second Line	:	SUITE 201
City	:	BOISE
State	:	ID
Zip	:	83704-5408
Country	:	US
Telephone Number	:	208-322-4114
Fax Number	:	208-322-4115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFF ALAN WALKER
Credential	:	D.C.
Telephone Number	:	208-322-4114

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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