Healthcare Provider Details

I. General information

NPI: 1245431501
Provider Name (Legal Business Name): SEAN PATRICK WALLIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 BOB WALLACE AVE SW SUITE B
HUNTSVILLE AL
35805
US

IV. Provider business mailing address

2915 BOB WALLACE AVE SW SUITE B
HUNTSVILLE AL
35805
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-8833
  • Fax:
Mailing address:
  • Phone: 256-880-8833
  • Fax: 931-438-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2213
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2213
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: