Organization
WALLACE CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN M PEARSON LPN (OFFICE MANAGER/CREDENTIALING)
(501) 724-5614
Entity
Organization
Contact information
Practice address
430 S. ELM ST, BALD KNOB, AR 72010
(501) 724-5614
Mailing address
PO BOX 1177, BALD KNOB, AR 72010-1177
(501) 724-5614
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1319
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350053970
MEDICARE RAIL ROAD PTAN
AR
Enumeration date
06/07/2016
Last updated
06/07/2016
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