Victoria Louisa Waller, DC, ATC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

34763 Issued in CA

Practice address

3646 Midway Dr # B
San Diego, CA 92110-5201

Phone

(619) 223-1617

NPI assigned

Feb 13, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Victoria Simpson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Coulsby Chiropractic, P.C.

  dba Peninsula Chiropractic Group

  • Sports Physician Chiropractor
  • San Diego, CA
  • NPI 1790115558
  NPD (past)
• Ian Ahearn Chiropractic Inc

  • Chiropractor
  • San Diego, CA
  • NPI 1518507334
  NPD (past)
• Matthew Sanicki Chiropractic Inc

  dba Point Loma Chiropractic

  • Chiropractor
  • San Diego, CA
  • NPI 1538604293
  NPD (past)

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1982237327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3646 MIDWAY DR # B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105201",
            "telephone_number": "619-317-1225",
            "fax_number": "619-223-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3646 MIDWAY DR # B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105201",
            "telephone_number": "619-223-1617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "VICTORIA",
        "middle_name": "LOUISA",
        "credential": "DC, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-13",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "BOC314534",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "34763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "SIMPSON",
            "credential": "DC, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William W Wallace, M.D.
• Carley Claire Wallenburg
• Austin Tanaka Waller
• Edna Waller, M.S.
• Giana Waller
• Riley Wallerstein
• Mykah Walley
• Shane Wallin
• Samantha Walling, RD
• Kelly Anne Wallis, FNP-C

• Chiropractor in San Diego, CA
• Providers in San Diego, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.