Individual
BRIANNA KYLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
690 RIVERSIDE AVE, ADRIAN, MI 49221-1544
(177) 594-1835
Mailing address
211 N UNION ST, TECUMSEH, MI 49286-1342
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301010808
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2301010808
—
MI
Enumeration date
04/22/2019
Last updated
01/03/2020
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