NPIMap

Organization Active NPI

Dr Kristie Wallace DC LLC

  • Chiropractor
  • Beaufort, SC
National Provider Identifier
1366732000
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3711 Issued in SC
Legal business name
DR KRISTIE WALLACE DC LLC
Practice address
703 Bladen St
Beaufort, SC 29902-4915
Phone
(843) 522-1115
Fax
(843) 522-1119
NPI assigned
Apr 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Authorized official

Name
Dr. Kristie Wallace, DCNPI 1770881070
Title
Chiropractor
Phone
(843) 522-1115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3711 SC Primary

Addresses

Primary practice location

703 Bladen St
Beaufort, SC 29902-4915

Mailing address

703 Bladen St
Beaufort, SC 29902-4915
Phone (843) 522-1115

Other names 1

  • Beaufort Chiropractic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1302739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1366732000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 BLADEN ST",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299024915",
            "telephone_number": "843-522-1115",
            "fax_number": "843-522-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 BLADEN ST",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299024915",
            "telephone_number": "843-522-1115",
            "fax_number": "843-522-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR KRISTIE WALLACE DC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-14",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "843-522-1115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaufort Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.