Healthcare Provider Details

I. General information

NPI: 1336229889
Provider Name (Legal Business Name): ALAN LEE WALKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 S. WILLOW SPRINGS ROAD
COUNTRYSIDE IL
60525
US

IV. Provider business mailing address

6555 S. WILLOW SPRINGS ROAD
COUNTRYSIDE IL
60525
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-9700
  • Fax: 776-767-3944
Mailing address:
  • Phone: 708-482-9700
  • Fax: 776-767-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001162
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: