Provider Demographics
NPI:1174599138
Name:WALKER, JASON CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:WALKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 EAGLE CTR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1847
Mailing Address - Country:US
Mailing Address - Phone:800-393-1064
Mailing Address - Fax:844-606-9378
Practice Address - Street 1:2 EAGLE CTR
Practice Address - Street 2:SUITE 2
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1847
Practice Address - Country:US
Practice Address - Phone:800-393-1064
Practice Address - Fax:844-606-9378
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1775Medicare UPIN