MR. Richard Dean Wallace, LICAC

NPI #1750458402 in Great Falls, Montana

Provider Information

NPI Number: 1750458402
Entity Type: Individual
Name: MR. Richard Dean Wallace, LICAC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Nutritionist
Credential: LICAC
Enumeration Date: Nov 29, 2006
Last Updated: Sep 11, 2025

Practice Location

Address: 914 13TH AVE SOUTH
City: Great Falls
State: Montana
ZIP Code: 59405
Phone: (406) 761-3767

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nutritionist	133N00000X	Primary
Dietitian, Registered	133V00000X
Acupuncturist	171100000X

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