NPIMap

Organization Active NPI

Jeffrey N Wallace DC PC

Doing business as Carroll Chiropractic and Sports Injury Center

  • Chiropractor
  • Westminster, MD
National Provider Identifier
1891813366
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S01780 Issued in MD
Legal business name
JEFFREY N WALLACE DC PC
Doing business as
Carroll Chiropractic and Sports Injury Center
Practice address
330 140 Village Rd
Unit 9a
Westminster, MD 21157-6127
Phone
(410) 876-8881
Fax
(410) 848-6343
NPI assigned
Mar 26, 2007
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Dr. Jeffrey N Wallace, D.C.NPI 1003866419
Title
Owner
Phone
(141) 087-6888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X S01780 MD Primary

Addresses

Primary practice location

330 140 Village Rd
Unit 9a
Westminster, MD 21157-6127

Mailing address

330 140 Village Rd Ste 9a
Westminster, MD 21157-6127
Phone (410) 876-8881

Other names 1

  • Carroll Chiropractic and Sports Injury Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060407000093 MD Part B Supplier - Clinic/Group Practice 8628087327 Receives reassigned benefits from 3 practitioners
Practice locations: Westminster, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1891813366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 140 VILLAGE RD STE 9A",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211576127",
            "telephone_number": "410-876-8881",
            "fax_number": "410-848-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 140 VILLAGE RD",
            "address_2": "UNIT 9A",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211576127",
            "telephone_number": "410-876-8881",
            "fax_number": "410-848-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY N WALLACE DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "141-087-6888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S01780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carroll Chiropractic and Sports Injury Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westminster, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.