Provider Demographics
NPI:1487097937
Name:WALLACE, CHRISTINA ERIN (LAC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ERIN
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:916 LYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-1820
Mailing Address - Country:US
Mailing Address - Phone:914-246-0148
Mailing Address - Fax:
Practice Address - Street 1:200 S. BROADWAY
Practice Address - Street 2:SOUTH BUILDING, SUITE #2-3
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-246-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist