Provider Demographics
NPI:1972796829
Name:BRAD WALKER DC PC
Entity type:Organization
Organization Name:BRAD WALKER DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-755-7246
Mailing Address - Street 1:PO BOX 8023
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-0023
Mailing Address - Country:US
Mailing Address - Phone:409-755-7246
Mailing Address - Fax:409-755-7629
Practice Address - Street 1:837 N MAIN ST SPC 110
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-1018
Practice Address - Country:US
Practice Address - Phone:409-755-7246
Practice Address - Fax:409-755-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105942Medicare PIN
TX609211Medicare PIN