Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIA-1557 | ID |
NPI | 1427597087 |
---|---|
Provider Name | Dr. Scott A Walker |
First Address | Boise, ID 83709-1193 |
Second Address | Boise, ID 83709-1193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 15/02/2017 |