Healthcare Provider Details

I. General information

NPI: 1750955332
Provider Name (Legal Business Name): ABIGAIL MAY ROVNAK WALLACE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PUNKIN TOWN RD STE 201
SOUTH BERWICK ME
03908-1846
US

IV. Provider business mailing address

2 PUNKIN TOWN RD STE 201
SOUTH BERWICK ME
03908-1846
US

V. Phone/Fax

Practice location:
  • Phone: 207-451-7682
  • Fax:
Mailing address:
  • Phone: 207-451-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR2801
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: