Matthew C Wallis, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4456 Issued in KY

Practice address

2725 James Sanders Blvd
Suite a
Paducah, KY 42001-8401

Phone

(270) 554-5114

Fax

(270) 554-5021

NPI assigned

Sep 20, 2006

Last updated

Feb 16, 2016By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Advancing Medical Solutions PSC

  • Multi-Specialty Clinic/Center
  • Paducah, KY
  • NPI 1699454249
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455580800000",
    "number": "1851499388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 JAMES SANDERS BLVD",
            "address_2": "SUITE A",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420018401",
            "telephone_number": "270-554-5114",
            "fax_number": "270-554-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 JAMES SANDERS BLVD",
            "address_2": "SUITE A",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420018401",
            "telephone_number": "270-554-5114",
            "fax_number": "270-554-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "MATTHEW",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "4456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "611375366",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terika Walker
• Ashley Wallace
• Hailey Wallace
• Patty A Wallace
• Tyler J Wallace, PMHNP-BC
• Michelle Walls, RN
• Walsh Chiropractic, PLLC
• Ellen E Walsh
• Jennifer Nicole Walston
• Angela Walters, COTA/L

• Chiropractor in Paducah, KY
• Providers in Paducah, KY by specialty
• Chiropractor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.