Provider Demographics
NPI:1023195781
Name:WALLER, DAVID M (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:WALLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:MICHAEL
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4550 SKY HARLAR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0629
Mailing Address - Country:US
Mailing Address - Phone:902-629-5087
Mailing Address - Fax:972-722-0096
Practice Address - Street 1:4210 RIDGE RD
Practice Address - Street 2:STE 102
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6602
Practice Address - Country:US
Practice Address - Phone:972-722-0054
Practice Address - Fax:972-722-0096
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU81254Medicare UPIN
TX609414Medicare PIN