Active NPI
Marcus L Waller, D.C.
- Chiropractor
- Desoto, TX
National Provider Identifier
1922501097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 13705
- Practice address
- 901 N Polk St Ste 349
Desoto, TX 75115-4014 - Phone
- (214) 613-1995
- NPI assigned
- Mar 14, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 13705 | TX | Primary |
Addresses
Primary practice location
901 N Polk St Ste 349
Desoto, TX 75115-4014
Mailing address
2923 Alyson Way
Grand Prairie, TX 75052-0429
Phone (708) 256-1435
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13705 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520985600000",
"number": "1922501097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2923 ALYSON WAY",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750520429",
"telephone_number": "708-256-1435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 N POLK ST STE 349",
"city": "DESOTO",
"state": "TX",
"postal_code": "751154014",
"telephone_number": "214-613-1995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "MARCUS",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-14",
"last_updated": "2018-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "13705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desoto, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.