MEDICARE: DR. MICHELLE JARVIS WALTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8428	AZ
2	111N00000X	Chiropractor	CHR.0007437	CO
3	111N00000X	Chiropractor	9617	TX
4	111N00000X	Chiropractor	3662	OK

General Provider Information

NPI Number	:	1811961105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE JARVIS WALTON D.C.

Provider Business Mailing Address
First Line	:	3320 TROUP HWY
Second Line	:	SUITE 240
City	:	TYLER
State	:	TX
Zip	:	75701-8395
Country	:	US
Telephone Number	:	903-526-9808
Fax Number	:	903-526-9819

Provider Business Practice Location Address
First Line	:	4727 GAILLARDIA PKWY STE 140
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-1927
Country	:	US
Telephone Number	:	405-936-4688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/12/2018

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