Individual
DR. DAVID MICHAEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
112 W GRAND AVE, RAINBOW CITY, AL 35906-3233
(256) 413-7749
(256) 413-7718
Mailing address
112 W GRAND AVE, RAINBOW CITY, AL 35906-3233
(256) 413-7749
(256) 413-7718
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
929
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510-70458
BLUE CROSS PROVIDER #
AL
Enumeration date
11/16/2006
Last updated
07/08/2007
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