Active NPI
Ida Sue Wallen, D.C.
- Rehabilitation Chiropractor
- Pinellas Park, FL
National Provider Identifier
1609045566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- CH002614
- Practice address
- 9375 US Highway 19 N Ste B
Pinellas Park, FL 33782-5420 - Phone
- (727) 577-7775
- Fax
- (727) 577-7776
- NPI assigned
- Feb 25, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | CH002614 | FL | Primary |
Addresses
Primary practice location
9375 US Highway 19 N Ste B
Pinellas Park, FL 33782-5420
Mailing address
9375 US Highway 19 N Ste B
Pinellas Park, FL 33782-5420
Phone (727) 577-7775
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH002614 | FL | MD | Rehabilitation Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296691200000",
"number": "1609045566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9375 US HIGHWAY 19 N STE B",
"city": "PINELLAS PARK",
"state": "FL",
"postal_code": "337825420",
"telephone_number": "727-577-7775",
"fax_number": "727-577-7776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9375 US HIGHWAY 19 N STE B",
"city": "PINELLAS PARK",
"state": "FL",
"postal_code": "337825420",
"telephone_number": "727-577-7775",
"fax_number": "727-577-7776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLEN",
"first_name": "IDA",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-25",
"last_updated": "2011-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "FL",
"license": "CH002614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinellas Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.