Healthcare Provider Details

I. General information

NPI: 1831260553
Provider Name (Legal Business Name): JASON ALEXANDER WALKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10139 HIGHWAY 12 SW
ROCHESTER WA
98579-8621
US

IV. Provider business mailing address

PO BOX 14027
TUMWATER WA
98511-4027
US

V. Phone/Fax

Practice location:
  • Phone: 360-273-2225
  • Fax: 360-273-0202
Mailing address:
  • Phone: 360-273-2225
  • Fax: 360-273-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034582
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: