Provider Demographics
NPI:1750406724
Name:CHUNG & WAGGONER HEALTH CENTER, INC
Entity type:Organization
Organization Name:CHUNG & WAGGONER HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-773-1113
Mailing Address - Street 1:7000 NW EXPRESSWAY ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3514
Mailing Address - Country:US
Mailing Address - Phone:405-773-1113
Mailing Address - Fax:405-773-1114
Practice Address - Street 1:7000 NW EXPRESSWAY ST
Practice Address - Street 2:SUITE H
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3514
Practice Address - Country:US
Practice Address - Phone:405-773-1113
Practice Address - Fax:405-773-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1013015064OtherDR. WAGGONER NPI
OK1639242647OtherDR. CHUNG NPI
OK1639242647OtherDR. CHUNG NPI
OK1013015064OtherDR. WAGGONER NPI
OK508881160Medicare ID - Type UnspecifiedDR. WAGGONER MEDICARE
OK376687986PMedicare ID - Type UnspecifiedDR. CHUNG MEDICARE
OKU51195Medicare UPIN