Wallace, Terrance Mark

Wallace, Terrance Mark is an sole proprietor health care provider with primary practice located at 411 County Road Uu , Hudson WI 54016-7576. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Wallace, Terrance Mark can be contacted via phone (715) 386-7700.

Contact Information

Primary practice address
411 County Road Uu Hudson WI 54016-7576
Phone: (715) 386-7700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 1632 Wisconsin

Profile Details

NPI number 1386732584
LBN Legal business name Wallace, Terrance Mark
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 11th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386732584 NPPES
Wisconsin Other 27F65WA BCBS
Wisconsin Other 44-40146 BCBS
Wisconsin Other 71907 BCBS
Wisconsin Other 392000316019 BCBS
Wisconsin MEDICAID 38765600 BCBS

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