Provider Demographics
NPI:1871649228
Name:WADDELL, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:WADDELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28281 CROWN VALLEY PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1483
Mailing Address - Country:US
Mailing Address - Phone:949-860-2400
Mailing Address - Fax:949-860-2411
Practice Address - Street 1:28281 CROWN VALLEY PKWY STE 125
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1483
Practice Address - Country:US
Practice Address - Phone:949-860-2400
Practice Address - Fax:949-860-2411
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor