Provider Demographics
NPI:1245431501
Name:WALLIS, SEAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:WALLIS
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 1:2915 BOB WALLACE AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805
Mailing Address - Country:US
Mailing Address - Phone:256-880-8833
Mailing Address - Fax:931-438-7006
Practice Address - Street 1:2915 BOB WALLACE AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805
Practice Address - Country:US
Practice Address - Phone:256-880-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2213111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor