Doctor Name: | DR. BROOK STEPHEN WALLACE |
NPI Number: | 1881624989 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 2625 |
Business Practice Address: | 1000 N Main St Suite 101 Fuquay Varina, NC - 275262056 |
Business Phone Number: | 9195770660 |
Business Fax Number: | 9195772286 |
Mailing Address: | 1000 N Main St, Suite 101 FUQUAY VARINA |
State: | NC |
Postal Code: | 275262056 |
Phone Number: | 9195770660 |
Fax Number: | 9195772286 |
NPI Enumeration Date: | 07/04/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 2625 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |