Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Cory Edward Wallace

Individual provider Non-emergency Medical Transport (VAN) · NPI 1871483420

Cory Edward Wallace is a Non-emergency Medical Transport (VAN) in Peoria, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2025
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Practice location Address checks out

3624 W Cassadaga Ct
Peoria, IL 61615-3952
Phone: (309) 922-9339
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Specialties & licences

Non-emergency Medical Transport (VAN) (primary) Taxonomy 343900000X (IL)

Record details

NPI number1871483420
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 7, 2025
Last updated in NPPESJuly 7, 2025
Certification dateJuly 7, 2025
Mailing address3624 W Cassadaga Ct, Peoria, IL 61615-3952

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