Individual
DR. TERRANCE MARK WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
411 COUNTY ROAD UU, HUDSON, WI 54016-7576
(715) 386-7700
Mailing address
PO BOX 9, HUDSON, WI 54016-0009
(715) 386-7700
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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