Healthcare Provider Details

I. General information

NPI: 1841001047
Provider Name (Legal Business Name): ALEXANDER WALLACE DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 1ST AVE NE STE 4
CEDAR RAPIDS IA
52402-5330
US

IV. Provider business mailing address

1962 1ST AVE NE STE 4
CEDAR RAPIDS IA
52402-5330
US

V. Phone/Fax

Practice location:
  • Phone: 319-550-1524
  • Fax:
Mailing address:
  • Phone: 319-550-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ALEXANDER M WALLACE
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 319-550-1524