Individual
DR. MATTHEW C WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2725 JAMES SANDERS BLVD, SUITE A, PADUCAH, KY 42001-8401
(270) 554-5114
(270) 554-5021
Mailing address
2725 JAMES SANDERS BLVD, SUITE A, PADUCAH, KY 42001-8401
(270) 554-5114
(270) 554-5021
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4456
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
611375366
TAX ID
KY
Enumeration date
09/20/2006
Last updated
02/16/2016
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