Individual
DR. BRIAN F WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
306 MAIN ST, BROOKVILLE, PA 15825-1222
(814) 849-5607
Mailing address
306 MAIN ST, BROOKVILLE, PA 15825-1222
(814) 849-5607
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC 006829L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016298480006
—
PA
01
—
75611
GEISINGER
PA
01
—
815891
FIRST PRIORITY HEALTH
—
Enumeration date
10/20/2005
Last updated
07/08/2007
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