MEDICARE: DR. WENDI CHEREE WALLIN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1617	NM

General Provider Information

NPI Number	:	1356383848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDI CHEREE WALLIN DC

Provider Business Mailing Address
First Line	:	3961 E LOHMAN AVE
Second Line	:	STE 22
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8269
Country	:	US
Telephone Number	:	575-652-3358
Fax Number	:	575-652-3360

Provider Business Practice Location Address
First Line	:	3961 E LOHMAN AVE
Second Line	:	STE 22
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8269
Country	:	US
Telephone Number	:	575-652-3358
Fax Number	:	575-652-3360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	12/14/2011

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