Provider Demographics
NPI:1801389945
Name:DR VANESSA WAUGH D C LLC
Entity Type:Organization
Organization Name:DR VANESSA WAUGH D C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON-WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-687-6454
Mailing Address - Street 1:516 LAKEVIEW RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3302
Mailing Address - Country:US
Mailing Address - Phone:727-687-6454
Mailing Address - Fax:727-466-1950
Practice Address - Street 1:516 LAKEVIEW RD STE 2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3302
Practice Address - Country:US
Practice Address - Phone:727-687-6454
Practice Address - Fax:727-466-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty