MEDICARE: DR. STEPHEN B WALLER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9828	TX

General Provider Information

NPI Number	:	1891727269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN B WALLER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 631907
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-0038
Country	:	US
Telephone Number	:	972-550-6190
Fax Number	:	972-550-6013

Provider Business Practice Location Address
First Line	:	1121 KINWEST PKWY
Second Line	:	SUITE 100
City	:	IRVING
State	:	TX
Zip	:	75063-3135
Country	:	US
Telephone Number	:	972-550-6190
Fax Number	:	972-550-6013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/15/2016

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