Wallace, Drew Michael

Wallace, Drew Michael is an individual health care provider with primary practice located at 17823 Poplar Grove Rd , Poplar Grove IL 61065-9014. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Wallace, Drew Michael can be contacted via phone (815) 765-3311.

Contact Information

Primary practice address
17823 Poplar Grove Rd Poplar Grove IL 61065-9014
Phone: (815) 765-3311
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 200014924 Illinois

Profile Details

NPI number 1669878625
LBN Legal business name Wallace, Drew Michael
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2014
Last updated Nov 18th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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