Provider Demographics
NPI:1043245384
Name:WADDELL, JAMES STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:WADDELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 NORTH OAK TRAFFICWAY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3345
Mailing Address - Country:US
Mailing Address - Phone:816-436-7153
Mailing Address - Fax:816-436-7158
Practice Address - Street 1:6716 NORTH OAK TRAFFICWAY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-3345
Practice Address - Country:US
Practice Address - Phone:816-436-7153
Practice Address - Fax:816-436-7158
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO085S008OtherAETNA
MO167788016OtherBCBS
MO752851907Medicaid
T73744Medicare UPIN
MO167788016OtherBCBS