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Provider Information for 1609045566

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. IDA SUE WALLEN D.C.

Gender: FEMALE

Individual NPI: 1609045566

Calendar   Last Updated:  2011-02-03
  Certification Date: 

Details

Name Value
NPI 1609045566
Enumeration Date 2008-02-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 9375 US HIGHWAY 19 N STE B
PINELLAS PARK, FL 33782-5420
United States

Phone: 727-577-7775 | Fax: 727-577-7776
View Map External Link
Primary Practice Address 9375 US HIGHWAY 19 N STE B
PINELLAS PARK, FL 33782-5420
United States

Phone: 727-577-7775 | Fax: 727-577-7776
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 111NR0400X - Chiropractor Rehabilitation FL CH002614