Provider Demographics
NPI:1154423325
Name:WALKER, CLIFFORD DAVID II (DC)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:DAVID
Last Name:WALKER
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 E 29TH ST
Mailing Address - Street 2:STE 108
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802
Mailing Address - Country:US
Mailing Address - Phone:979-846-2969
Mailing Address - Fax:979-846-2965
Practice Address - Street 1:4001 E 29TH ST
Practice Address - Street 2:STE 108
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-846-2969
Practice Address - Fax:979-846-2965
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605187OtherBCBS
TX6499OtherCHIROPRACTIC LICENSE
U55682Medicare UPIN
TXTXB132231Medicare PIN