Active NPI
Terrance Mark Wallace, DC
- Chiropractor
- Hudson, WI
National Provider Identifier
1386732584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1632
- Practice address
- 411 County Road Uu
Hudson, WI 54016-7576 - Phone
- (715) 386-7700
- NPI assigned
- Oct 11, 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 | 1632 | WI | Primary |
Addresses
Primary practice location
411 County Road Uu
Hudson, WI 54016-7576
Mailing address
PO Box 9
Hudson, WI 54016-0009
Phone (715) 386-7700
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27F65WA | Other | WI | BCBS |
| 44-40146 | Other | WI | MEDICA |
| 71907 | Other | WI | HEALTH PARTNERS |
| 392000316019 | Other | WI | BLUE CROSS WI |
| 38765600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1632 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386732584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "HUDSON",
"state": "WI",
"postal_code": "540160009",
"telephone_number": "715-386-7700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 COUNTY ROAD UU",
"city": "HUDSON",
"state": "WI",
"postal_code": "540167576",
"telephone_number": "715-386-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "TERRANCE",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "1632",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "27F65WA",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "44-40146",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "71907",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS WI",
"identifier": "392000316019",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38765600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.