Provider Demographics
NPI:1265507883
Name:WAUGH, KEVIN L (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:WAUGH
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 1:9776 HOLMAN RD NW STE 109
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2000
Mailing Address - Country:US
Mailing Address - Phone:206-782-8800
Mailing Address - Fax:206-782-2777
Practice Address - Street 1:9776 HOLMAN RD NW #109
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-782-8800
Practice Address - Fax:206-782-2777
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor