Active NPI
Caleb Dylan Wallace, DC
- Chiropractor
- Moore, OK
National Provider Identifier
1508775420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4735
- Practice address
- 1101 SW 30TH CT Ste B
Moore, OK 73160-2887 - Phone
- (405) 759-2233
- NPI assigned
- Sep 4, 2026
- 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 | 4735 | OK | Primary |
Addresses
Primary practice location
1101 SW 30TH CT Ste B
Moore, OK 73160-2887
Mailing address
1101 SW 30TH CT Ste B
Moore, OK 73160-2887
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788480000000",
"number": "1508775420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 SW 30TH CT STE B",
"city": "MOORE",
"state": "OK",
"postal_code": "731602887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 SW 30TH CT STE B",
"city": "MOORE",
"state": "OK",
"postal_code": "731602887",
"telephone_number": "405-759-2233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "CALEB",
"middle_name": "DYLAN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-09-04",
"last_updated": "2026-09-04",
"certification_date": "2026-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OK",
"license": "4735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.