Healthcare Provider Details

I. General information

NPI: 1750305132
Provider Name (Legal Business Name): WALTER P CREEL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12051 HWY 84 WEST
JENA LA
71342
US

IV. Provider business mailing address

PO BOX 1333
JENA LA
71342
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2022
  • Fax: 318-992-2037
Mailing address:
  • Phone: 318-992-2022
  • Fax: 318-992-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number513
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: