Jacob Waller, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH34455 Issued in WA

Practice address

10315 19TH Ave SE
Suite 106
Everett, WA 98208-4268

Phone

(425) 338-5537

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Towers Family ChiropracticGroup PAC ID 3173925625, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Towers Family Chiropractic

  • Chiropractor
  • Redmond, WA
  • NPI 1306429725
  Medicare reassignment Care Compare group NPD
• Chirobody

  • Sports Physician Chiropractor
  • Everett, WA
  • NPI 1093173049
  NPD (past)
• Jong Il Lee DC,PS

  • Chiropractor
  • Mill Creek, WA
  • NPI 1942539358
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458864000000",
    "number": "1609954650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10315 19TH AVE SE",
            "address_2": "SUITE 106",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084268",
            "telephone_number": "425-338-5537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10315 19TH AVE SE",
            "address_2": "SUITE 106",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084268",
            "telephone_number": "425-338-5537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH34455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTIRES/WC",
            "identifier": "0203575",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Ann Wallace, R.N.
• Kent William Wallace, PA-C, ARNP
• Robin L Wallace, ARNP
• Sarah Wallace
• Lorreta Akinyi Wallen
• Eric Wallin
• Jonathan Thomas Wallis, MA, LMHCA
• Megan K Wallis, MSW
• Walter Merle Wallis, MD
• Daniel Wallulis

• Chiropractor in Everett, WA
• Providers in Everett, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.