Provider Demographics
NPI:1427026053
Name:WALLIS, KAREN FAYE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:FAYE
Last Name:WALLIS
Suffix:
Gender:F
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:PO BOX 3905
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-3905
Mailing Address - Country:US
Mailing Address - Phone:918-331-5390
Mailing Address - Fax:918-331-5347
Practice Address - Street 1:2401 NOWATA PL
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-4733
Practice Address - Country:US
Practice Address - Phone:918-331-5390
Practice Address - Fax:918-331-5347
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5129060OtherAETNA