Provider Demographics
NPI:1538180138
Name:WALKER, BRADLEY DALE (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DALE
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 1:4333 COUNTY ROAD 207
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-9127
Mailing Address - Country:US
Mailing Address - Phone:330-907-9101
Mailing Address - Fax:
Practice Address - Street 1:4333 COUNTY ROAD 207
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-9127
Practice Address - Country:US
Practice Address - Phone:330-907-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWA0405301Medicare ID - Type Unspecified