Provider Demographics
NPI:1699584631
Name:WALLACE, ALEXANDER M (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:M
Last Name:WALLACE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 1ST AVE NE STE 4
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5330
Mailing Address - Country:US
Mailing Address - Phone:319-364-0030
Mailing Address - Fax:
Practice Address - Street 1:1962 1ST AVE NE STE 4
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5330
Practice Address - Country:US
Practice Address - Phone:319-364-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor