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Individual
DR. TERRANCE MARK WALLACE
Active
Individual
DR. TERRANCE MARK WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1632
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27F65WA
BCBS
WI
05
—
38765600
—
WI
01
—
392000316019
BLUE CROSS WI
WI
01
—
44-40146
MEDICA
WI
01
—
71907
HEALTH PARTNERS
WI
Enumeration date
10/11/2006
Last updated
07/08/2007
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