Brook S. Wallace PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2625 Issued in NC

Legal business name

BROOK S. WALLACE PA

Practice address

1000 N Main St
Suite 101
Fuquay Varina, NC 27526-2056

Phone

(919) 577-0660

Fax

(919) 577-2286

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brook Stephen Wallace, D.CNPI 1881624989

Title

Owner

Phone

(919) 577-0660

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Chiropractic Partners Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brook Stephen Wallace, DC

  • Chiropractor
  • Fuquay Varina, NC
  • NPI 1881624989
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1306915731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N MAIN ST",
            "address_2": "SUITE 101",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262056",
            "telephone_number": "919-577-0660",
            "fax_number": "919-577-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N MAIN ST",
            "address_2": "SUITE 101",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262056",
            "telephone_number": "919-577-0660",
            "fax_number": "919-577-2286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOK S. WALLACE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BROOK",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-577-0660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS #",
            "identifier": "0836G",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN #",
            "identifier": "612942",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890836G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chiropractic Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kurt Stacy Brooks, PT
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• Brown Orthopaedic Surgery & Sports Medicine Center, P.a.
• Olivia Marie Bruff-Younts, PA
• Megan Bryan

• Chiropractor in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.