Provider Demographics
NPI:1538343496
Name:WALKER WELLNESS CHIROPRACTIC
Entity type:Organization
Organization Name:WALKER WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-547-0080
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0011
Mailing Address - Country:US
Mailing Address - Phone:218-547-0080
Mailing Address - Fax:218-547-0081
Practice Address - Street 1:507 FRONT STREET WEST
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484
Practice Address - Country:US
Practice Address - Phone:218-547-0080
Practice Address - Fax:218-547-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN133J7SCOtherBC/BS OF MINNESOTA
MNC03565Medicare PIN