Provider Demographics
NPI:1841936218
Name:WAGABAZA, GABRIELLE KAYOBYO (DC)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:KAYOBYO
Last Name:WAGABAZA
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 1:7997 WADE BLVD APT 4113
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5297
Mailing Address - Country:US
Mailing Address - Phone:207-899-5261
Mailing Address - Fax:
Practice Address - Street 1:1518 LEGACY DR STE 280
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6042
Practice Address - Country:US
Practice Address - Phone:214-775-9953
Practice Address - Fax:214-775-9953
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor