Brittany B Wallace, DC
Individual provider Active NPI Chiropractor · Marquette, IA
NPI 1104446756 · NPPES record last updated Apr 23, 2020
Key facts
- NPI
- 1104446756
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 100810 (IA)
- Practice address
- 129 North St
Marquette, IA 52158-7706 - Phone
- (563) 873-5422
- NPI assigned
- Apr 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100810 | IA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primitive Health Chiropractic and Wellness Center, LLC | Chiropractor | Current |
Accepting new patients |
| Lund Family Chiropractic, Inc. | Chiropractor | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 100810 | IA | Yes |
Addresses
Primary practice location
129 North St
Marquette, IA 52158-7706
Mailing address
59815 Oak Grove LN
Prairie Du Chien, WI 53821-8526
Phone (507) 459-7407
Other providers in Marquette, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.