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Individual
GARRETT GENE WALLACE
Active
Individual
GARRETT GENE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6236
OR
111N00000X
Chiropractor
CH13851
FL
111N00000X
Chiropractor
PENDING
OR
Other
Enumeration date
01/05/2022
Last updated
09/07/2022
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