Individual
MITCHELL DEAN WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5931 W HEDGEHOG PL # B105, PHOENIX, AZ 85083-6559
(309) 255-2905
Mailing address
5931 W HEDGEHOG PL # B105, PHOENIX, AZ 85083-6559
(309) 255-2905
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038-009141
IL
111N00000X
Chiropractor
Primary
8330
AZ
111NI0013X
Independent Medical Examiner Chiropractor
8330
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05527512
BCBS
IL
Enumeration date
11/16/2006
Last updated
03/01/2026
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