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Organization

BROOK S. WALLACE PA

Active
Other names
Chiropractic Partners
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BROOK STEPHEN WALLACE D.C (OWNER)
(919) 577-0660
Entity
Organization

Contact information

Practice address
1000 N MAIN ST, SUITE 101, FUQUAY VARINA, NC 27526-2056
(919) 577-0660
(919) 577-2286
Mailing address
1000 N MAIN ST, SUITE 101, FUQUAY VARINA, NC 27526-2056
(919) 577-0660
(919) 577-2286

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2625
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0836G
BCBS #
NC
01
612942
ACN #
NC
05
890836G
NC
Enumeration date
11/07/2006
Last updated
03/07/2008
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