Provider Demographics
NPI:1932269891
Name:STAPLETON-WAUGH, VANESSA (DC)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:STAPLETON-WAUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:WAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:516 LAKEVIEW RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3302
Mailing Address - Country:US
Mailing Address - Phone:727-687-6454
Mailing Address - Fax:727-466-1950
Practice Address - Street 1:516 LAKEVIEW ROAD
Practice Address - Street 2:STE 2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3302
Practice Address - Country:US
Practice Address - Phone:727-687-6454
Practice Address - Fax:727-466-1950
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15851Medicare UPIN