Provider Demographics
NPI:1194741348
Name:WALKUP, THALIA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:THALIA
Middle Name:ANN
Last Name:WALKUP
Suffix:
Gender:F
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0185
Mailing Address - Country:US
Mailing Address - Phone:580-931-9898
Mailing Address - Fax:580-931-8809
Practice Address - Street 1:1327 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2134
Practice Address - Country:US
Practice Address - Phone:580-931-9898
Practice Address - Fax:580-931-8809
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU61127Medicare UPIN