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General NPI Number Information
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NPI Number | 1992926208
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Entity Type | Organization
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Legal Business Name | WALLS FAMILY CHIROPRACTIC INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 GRAND AVE
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City | ARDMORE
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State | OK
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Zip | 73401-4345
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Country | US
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Telephone | 580-223-2835
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Fax | 580-223-6050
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Provider Business Mailing Address
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Address Line | 800 GRAND AVE
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City | ARDMORE
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State | OK
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Zip | 73401-4345
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Country | US
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Telephone | 580-223-2835
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Fax | 580-223-6050
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BUEL M WALLS
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Credential | DC
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Telephone | 580-223-2835
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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 | 3195
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License Number State | OK
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