Individual
MARK RICHARD WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
9337 W 75TH ST, OVERLAND PARK, KS 66204
(913) 722-3200
(913) 432-8392
Mailing address
9337 W 75TH ST, OVERLAND PARK, KS 66204
(913) 722-3200
(913) 432-8392
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
04348
KS
111N00000X
Chiropractor
6478
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063617918
NPI
KS
Enumeration date
05/30/2008
Last updated
09/10/2008
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