Individual
DR. BROOK STEPHEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1000 N MAIN ST, SUITE 101, FUQUAY VARINA, NC 27526-2056
(919) 577-0660
(919) 577-2286
Mailing address
1000 N MAIN ST, SUITE 101, FUQUAY VARINA, NC 27526-2056
(919) 577-0660
(919) 577-2286
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2625
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0836G
BCBS PROVIDER NUMBER
NC
05
—
890836G
—
NC
Enumeration date
07/04/2006
Last updated
07/09/2007
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