Provider Demographics
NPI:1912045840
Name:WADDELL, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:WADDELL
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 1:4855 ATHERTON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1026
Mailing Address - Country:US
Mailing Address - Phone:408-871-9355
Mailing Address - Fax:408-871-8511
Practice Address - Street 1:4855 ATHERTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1026
Practice Address - Country:US
Practice Address - Phone:408-871-9355
Practice Address - Fax:408-871-8511
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor