Mitchell Dean Waller, DC in Phoenix, AZ - Medicare Chiropractic Provider

Mitchell Dean Waller, DC is a medicare enrolled "Chiropractor" provider in Phoenix, Arizona. He went to Logan College Of Chiropractic and graduated in 2000 and has 26 years of diverse experience with area of expertise as Chiropractic. He is a member of the group practice Estrella Pkwy Medical Center Llc and his current practice location is 5931 W Hedgehog Pl # B105, Phoenix, Arizona. You can reach out to his office (for appointments etc.) via phone at (309) 255-2905.

Mitchell Dean Waller is licensed to practice in Arizona (license number 8330) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1457424467.

Contact Information

	Mitchell Dean Waller, DC
	5931 W Hedgehog Pl # B105, Phoenix, AZ 85083-6559
	(309) 255-2905
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Mitchell Dean Waller
Gender	Male
Speciality	Chiropractic
Experience	26 Years
Location	5931 W Hedgehog Pl # B105, Phoenix, Arizona
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Mitchell Dean Waller attended and graduated from Logan College Of Chiropractic in 2000

NPI Data:

NPI Number: 1457424467
Provider Enumeration Date: 11/16/2006
Last Update Date: 03/01/2026

Medicare PECOS Information:

PECOS PAC ID: 3870481583
Enrollment ID: I20140602001724

Medical Identifiers

Medical identifiers for Mitchell Dean Waller such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1457424467	NPI	-	NPPES
05527512	Other	IL	BCBS

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
111N00000X	Chiropractor	8330 (Arizona)	Primary
111NI0013X	Chiropractor - Independent Medical Examiner	8330 (Arizona)	Secondary
111N00000X	Chiropractor	038-009141 (Illinois)	Secondary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Estrella Pkwy Medical Center Llc	6002067410	3

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mitchell Dean Waller allows following entities to bill medicare on his behalf.

Provider Name	Estrella Pkwy Medical Center Llc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1871546036 PECOS PAC ID: 6002067410 Enrollment ID: O20121113000144

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mitchell Dean Waller is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mitchell Dean Waller, DC 5931 W Hedgehog Pl # B105, Phoenix, AZ 85083-6559 Ph: (309) 255-2905	Mitchell Dean Waller, DC 5931 W Hedgehog Pl # B105, Phoenix, AZ 85083-6559 Ph: (309) 255-2905

Reviews and Comments

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Mitchell Dean Waller, DC - Medicare Chiropractor in Phoenix, AZ