Active NPI
Denver R Wallace, D.C.
- Chiropractor
- Bald Knob, AR
National Provider Identifier
1003889148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1319
- Practice address
- 430 South Elm Street
Bald Knob, AR 72010-1177 - Phone
- (501) 724-5614
- Fax
- (501) 724-5614
- NPI assigned
- Feb 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1319 | AR | Primary |
Addresses
Primary practice location
430 South Elm Street
Bald Knob, AR 72010-1177
Mailing address
430 South Elm Street
P.O. Box 1177
Bald Knob, AR 72010-1177
Phone (501) 724-5614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120424000106 | AR | Practitioner - Chiropractic | 4284896085 | Practice locations: Bald Knob, AR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1319 | AR | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wallace Chiropractic Clinic | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Bald Knob, AR
- NPI 1801245295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201132800000",
"number": "1003889148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 SOUTH ELM STREET",
"address_2": "P.O. BOX 1177",
"city": "BALD KNOB",
"state": "AR",
"postal_code": "720101177",
"telephone_number": "501-724-5614",
"fax_number": "501-724-5614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 SOUTH ELM STREET",
"city": "BALD KNOB",
"state": "AR",
"postal_code": "720101177",
"telephone_number": "501-724-5614",
"fax_number": "501-724-5614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DENVER",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-09",
"last_updated": "2008-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AR",
"license": "1319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bald Knob, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.