Provider Demographics
NPI:1912085143
Name:WADDELL, CHRISTOPHER N (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:N
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 1:2621 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2913
Mailing Address - Country:US
Mailing Address - Phone:405-878-1340
Mailing Address - Fax:405-878-1341
Practice Address - Street 1:2621 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2913
Practice Address - Country:US
Practice Address - Phone:405-878-1340
Practice Address - Fax:405-878-1341
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor