Provider Demographics
NPI:1083906036
Name:WALL, WILLIAM ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLAN
Last Name:WALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:400 BYPASS LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-6351
Mailing Address - Country:US
Mailing Address - Phone:936-327-3140
Mailing Address - Fax:936-327-3282
Practice Address - Street 1:400 BYPASS LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-6351
Practice Address - Country:US
Practice Address - Phone:936-327-3140
Practice Address - Fax:936-327-3282
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00825UMedicare UPIN