Wallace Chiropractic Clinic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1319 Issued in AR

Legal business name

WALLACE CHIROPRACTIC CLINIC

Practice address

430 S. Elm St
Bald Knob, AR 72010

Phone

(501) 724-5614

NPI assigned

Jun 7, 2016

Organization subpart

No

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

Authorized official

Name

Megan M Pearson, LPN

Title

Office Manager/Credentialing

Phone

(501) 724-5614

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denver R Wallace, D.C.

  • Chiropractor
  • Bald Knob, AR
  • NPI 1003889148
  NPD (past)
• Taylor Wallace, DC

  • Chiropractor
  • Bald Knob, AR
  • NPI 1982028270
  NPD (past)

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1801245295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1177",
            "city": "BALD KNOB",
            "state": "AR",
            "postal_code": "720101177",
            "telephone_number": "501-724-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 S. ELM ST",
            "city": "BALD KNOB",
            "state": "AR",
            "postal_code": "72010",
            "telephone_number": "501-724-5614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "PEARSON",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER/CREDENTIALING",
        "authorized_official_telephone_number": "501-724-5614",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "1319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD PTAN",
            "identifier": "350053970",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phillip Moore, D.C.
• Imi Mvere
• Shelly Rutledge, PHARM.D.
• Southern Dental Group Bald Knob, PLLC
• Ladonna Sue Thompson, MSE, CCC/SLP
• Wallace Chiropractic Clinic LLC
• Denver R Wallace, D.C.
• Taylor Wallace, DC
• Haley Owens Weaver, PHARM. D.
• Kristin Wood, APRN

• Chiropractor in Bald Knob, AR
• Providers in Bald Knob, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.