Brian William Wallace, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00676500 Issued in NJ

Practice address

139 Morristown Rd
Bernardsville, NJ 07924-2633

Phone

(908) 221-0808

NPI assigned

May 17, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2009

Medicare assignment

May accept Medicare assignment

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.

• Somerset Hills Chiropractic LLC

  • Chiropractor
  • Bernardsville, NJ
  • NPI 1811296353
  Medicare reassignment NPD

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

{
    "created_epoch": "1274054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274054400000",
    "number": "1598083495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 SENEY DR",
            "city": "BERNARDSVILLE",
            "state": "NJ",
            "postal_code": "079241849",
            "telephone_number": "908-221-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 MORRISTOWN RD",
            "city": "BERNARDSVILLE",
            "state": "NJ",
            "postal_code": "079242633",
            "telephone_number": "908-221-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRIAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-17",
        "last_updated": "2010-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00676500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Tretola, PA-C
• Izabella Ulicki, PT, DPT
• Village Super Market of NJ LP
• John J Visci, MD
• Walgreen Co
• William R Wallace, D.C.
• Jane Marie Webber, PHD
• Well Life RX, LLC
• Catherine Wellington, RN
• Wendy K. Stinson DPM

• Chiropractor in Bernardsville, NJ
• Providers in Bernardsville, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; 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.