Provider Demographics
NPI:1811961105
Name:WALTON, MICHELLE JARVIS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JARVIS
Last Name:WALTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3320 TROUP HWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8395
Mailing Address - Country:US
Mailing Address - Phone:903-526-9808
Mailing Address - Fax:903-526-9819
Practice Address - Street 1:4727 GAILLARDIA PKWY STE 140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-1927
Practice Address - Country:US
Practice Address - Phone:405-936-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8428111N00000X
COCHR.0007437111N00000X
TX9617111N00000X
OK3662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D1130Medicare ID - Type Unspecified
TXU89343Medicare UPIN