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

Dr. Timothy Mark Wallace, DC

Individual provider Chiropractor · NPI 1063438307

Dr. Timothy Mark Wallace, DC is a Chiropractic in Phelan, California. Graduated from Los Angeles College of Chiropractic in 1999, 27 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
27
Trained at
Los Angeles College of Chiropractic
Licensed in
CA
In the registry since
2006
What do these letters mean?
DC — Doctor of Chiropractic
A licensed chiropractor.

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Practice location Address checks out

4357 Phelan Rd
Phelan, CA 92371-7675
Phone: (760) 868-4481
Fax: (760) 868-1879
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Chiropractor (primary) Taxonomy 111N00000X · Licence 23400 (CA)

Record details

NPI number1063438307
Entity typeIndividual (Type 1)
GenderMale
Credentials DC
Sole proprietorYes
NPI enumeratedJuly 13, 2006
Last updated in NPPESJanuary 27, 2012
Mailing address4357 Phelan Rd, Phelan, CA 92371-7675

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCHIROPRACTIC
Medical schoolLOS ANGELES COLLEGE OF CHIROPRACTIC
Graduated 1999 (27 years in practice)
Accepts Medicare assignment Not indicated

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