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General NPI Number Information
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NPI Number | 1417785296
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Entity Type | Individual
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Provider Name | TONI WALLIS DC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1000 FIANNA WAY
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City | FORT SMITH
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State | AR
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Zip | 72916-8285
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Country | US
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Telephone | 479-222-4698
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Fax | 479-308-0264
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Provider Business Mailing Address
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Address Line | 3204 AUBURN DR
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City | ROWLETT
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State | TX
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Zip | 75088-6647
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Country | US
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Telephone | 903-343-2654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15064
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License Number State | TX
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