Search › Illinois › 104100000X
Daniel Wallace, DSW
NPI 1841771292 · on the registry since 2018 · sole proprietor
Practice
- Address
- 22997 Kristine Ln
Richton Park, IL 60471 - Phone
- (708) 925-7022
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-01-30
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois