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DR. TAYLOR WALLACE DC

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1982028270

Individual Registrant:
DR. TAYLOR  WALLACE DC
Gender: M
Not Sole Proprietor

Location and contact information for practice:
430 SOUTH ELM STREET  BALD KNOB, AR 72010-1177 US
Tel: 501-724-5614  Fax: 501-724-5614

Contact information for business:
PO BOX 1177  BALD KNOB, AR 72010-1177 US
Tel: 501-724-5614  Fax: 501-724-5614

Registration Information:
NPI: 1982028270
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
AR16058

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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