Jeffrey David Wallace, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301008560 Issued in MI

Practice address

820 Charlevoix Dr
Suite 210
Grand Ledge, MI 48837-8188

Phone

(517) 622-2273

Fax

(517) 622-2223

NPI assigned

Oct 27, 2005

Sex

Male

Sole proprietor

Yes

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 MI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Complete Health Chiropractic, PC

  • Chiropractor
  • Grand Ledge, MI
  • NPI 1316108848
  Medicare reassignment NPD Authorized official
• Chiromed Center, Inc

  dba Kal Family Chiropractic

  • Chiropractor
  • Owosso, MI
  • NPI 1467561225
  NPD (past)
• Sam Chan PC

  dba Chiromed Center Inc

  • Chiropractor
  • Owosso, MI
  • NPI 1245408301
  NPD (past)

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679563928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 CHARLEVOIX DR",
            "address_2": "SUITE 210",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488378188",
            "telephone_number": "517-622-2273",
            "fax_number": "517-622-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 CHARLEVOIX DR",
            "address_2": "SUITE 210",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488378188",
            "telephone_number": "517-622-2273",
            "fax_number": "517-622-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JEFFREY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Rene Van Horn, D.C.
• Janet Sterk Van Wieren X
• Dawne Marie Velianoff, LMSW
• James Anthony Voltattorni, DDS
• Walgreen Co (Walgreens #13150)
• Tara Weaver
• Marci Westman
• Dinah Mary Weststrate, LMSW
• Michal Wetmore
• Megan Wilkes, LMSW

• Chiropractor in Grand Ledge, MI
• Providers in Grand Ledge, MI by specialty
• Chiropractor in Michigan

• 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.
• 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.