Healthcare Provider Details

I. General information

NPI: 1710371190
Provider Name (Legal Business Name): CHRISTINE WALLEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE R WALLEN DC

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 16TH AVE SW
CEDAR RAPIDS IA
52404-1453
US

IV. Provider business mailing address

410 CAMDEN ST
NORTH LIBERTY IA
52317-7604
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number076948
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: