Provider Demographics
NPI:1669844296
Name:WAGGONER, CHASE DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:DANIEL
Last Name:WAGGONER
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 1:400 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-2286
Mailing Address - Country:US
Mailing Address - Phone:260-499-4911
Mailing Address - Fax:
Practice Address - Street 1:400 UNION ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-2286
Practice Address - Country:US
Practice Address - Phone:260-499-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002862A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor