Clara Bailey Wallace, DC | |
46 Lynn Ln Ste 1, Starkville, MS 39759-9269 | |
(662) 546-4400 | |
Not Available |
Full Name | Clara Bailey Wallace |
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Gender | Female |
Speciality | Chiropractor |
Location | 46 Lynn Ln Ste 1, Starkville, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1629795885 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | CHIR010833 (Georgia) | Primary |
Provider Name | Synergy Sports Wellness Institute |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1952770851 PECOS PAC ID: 6800106857 Enrollment ID: O20151104000957 |
Mailing Address | Practice Location Address |
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Clara Bailey Wallace, DC 46 Lynn Ln Ste 1, Starkville, MS 39759-9269 Ph: (662) 546-4400 | Clara Bailey Wallace, DC 46 Lynn Ln Ste 1, Starkville, MS 39759-9269 Ph: (662) 546-4400 |
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