Provider Demographics
NPI:1386745412
Name:WALKER, MICHAEL EDWIN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWIN
Last Name:WALKER
Suffix:
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 1:1705 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1136
Mailing Address - Country:US
Mailing Address - Phone:989-792-3019
Mailing Address - Fax:989-792-3019
Practice Address - Street 1:1705 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1136
Practice Address - Country:US
Practice Address - Phone:989-792-3019
Practice Address - Fax:989-792-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301300294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U23013Medicare UPIN
MIP36990001Medicare ID - Type UnspecifiedPROVIDER NUMBER