Provider Demographics
NPI:1467657585
Name:JAMES S WADDELL DC PC
Entity Type:Organization
Organization Name:JAMES S WADDELL DC PC
Other - Org Name:NORTH OAK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-436-7153
Mailing Address - Street 1:6716 N OAK TRFY
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:816-436-7158
Mailing Address - Fax:
Practice Address - Street 1:6716 N 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:816-436-7158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE004436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO752851907Medicaid
MOT73744Medicare UPIN
MOA460000Medicare ID - Type UnspecifiedGROUP NUMBER