Brianna Kyle Wallace, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301010808 Issued in MI

Practice address

690 Riverside Ave
Adrian, MI 49221-1544

Phone

(177) 594-1835

NPI assigned

Apr 22, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Spectrum Chiropractic and Health

  • Chiropractor
  • Adrian, MI
  • NPI 1952931172
  Medicare reassignment NPD Authorized official
• Hometown Chiropractic Spring Arbor, PLLC

  • Chiropractor
  • Spring Arbor, MI
  • NPI 1972077113
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1164085411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N UNION ST",
            "city": "TECUMSEH",
            "state": "MI",
            "postal_code": "492861342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 RIVERSIDE AVE",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211544",
            "telephone_number": "177-594-1835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRIANNA",
        "middle_name": "KYLE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2301010808",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Adrian",
            "affiliation": "N",
            "address_1": "690 Riverside Ave",
            "city": "Adrian",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492211544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Danielle Rose Wagley
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• Wal-Mart Stores East, LP
• Karlyn Deanne Waldeck, DO
• Walgreen Co
• Vanessa Nicole Wallace
• Natalie Walton, PT, DPT
• Shannon Lee Waltz
• Emily Brooke Walworth, RBT
• Angel Christina Ward

• All providers in Adrian, MI
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.