Provider Demographics
NPI:1760028054
Name:WASKE, PAMELA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:WASKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:DLUGOSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4977 OLEATHA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1224
Mailing Address - Country:US
Mailing Address - Phone:815-236-5747
Mailing Address - Fax:
Practice Address - Street 1:3123 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2303
Practice Address - Country:US
Practice Address - Phone:815-236-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor