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General NPI Number Information
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NPI Number | 1043578560
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Entity Type | Organization
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Legal Business Name | WALKER FAMILY CHIROPRACTIC P.S.C.
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 156 KENWOOD CIR NE
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City | BEMIDJI
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State | MN
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Zip | 56601-5730
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Country | US
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Telephone | 218-766-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 302 E KENNEDY ST
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City | ALGONA
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State | IA
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Zip | 50511-3446
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JACOB WAKER
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Credential | D.C.
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Telephone | 515-341-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5667
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License Number State | MN
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