DR. Timothy Mark Wallace, D.C.

NPI #1063438307 in Phelan, California

Provider Information

NPI Number: 1063438307
Entity Type: Individual
Name: DR. Timothy Mark Wallace, D.C.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Chiropractor
Credential: D.C.
Enumeration Date: Jul 13, 2006
Last Updated: Jan 27, 2012

Practice Location

Address: 4357 PHELAN RD
City: Phelan
State: California
ZIP Code: 92371-7675
Phone: (760) 868-4481

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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