SHANE EDWARD WALLACE DC
NPI 1639753239
Chiropractor in Brooklyn, MI

Active since May 10, 2021Accepts Medicare Assignment
9909 WAMPLERS LAKE RD, BROOKLYN, MI 49230(517) 592-8208 Get Directions Write a Review

NPPES record last updated: May 10, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shane Edward Wallace Dc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE EDWARD WALLACE DC (NPI 1639753239) is an individual chiropractor in Brooklyn, Michigan, licensed in Michigan (2301011096) and active in the NPI registry since May 2021. He is a graduate of Life Chiropractic College (2019).

NPPES Registry Identity

NPI1639753239
Entity TypeIndividualMale
Primary Taxonomy111N00000X
Provider Legal NameSHANE EDWARD WALLACECredential: DC
Location Address9909 WAMPLERS LAKE RDBrooklyn, MI 49230-9503
Mailing Address9909 Wamplers Lake RdBrooklyn, MI 49230-9503 · (517) 592-8208
Sole ProprietorNo
Medical School CMSLife Chiropractic CollegeGraduated 2019
Enumeration DateMay 10, 2021
NPPES CertifiedMay 10, 2021
NPI 1639753239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License Licensed in MI · 2301011096
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
9909 WAMPLERS LAKE RD, Brooklyn, MI 49230

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Shane Edward Wallace Dc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2769996966
PECOS Enrollment IDI20250910000739

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Chiropractor
9909 WAMPLERS LAKE RD
BROOKLYN, MI 49230
Chiropractor
9909 WAMPLERS LAKE RD
BROOKLYN, MI 49230

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Wallace's NPI number?

The NPI number for Shane Wallace is 1639753239. It was assigned to this individual provider in the NPPES registry on May 10, 2021.

Where is Shane Wallace located?

Shane Wallace practices at 9909 Wamplers Lake Rd, Brooklyn, MI 49230. The listed phone number is (517) 592-8208.

What is Shane Wallace's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Shane Wallace enrolled in Medicare?

Yes. Shane Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Shane Wallace accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company and Priority Health list Shane Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shane Wallace was last updated on May 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.