Provider Demographics
NPI:1982778262
Name:WALDDON, JEFFERY LG (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:LG
Last Name:WALDDON
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 1:22833 BOTHELL - EVERETT HWY STE. 144
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-483-8525
Mailing Address - Fax:928-223-1540
Practice Address - Street 1:22833 BOTHELL - EVERETT HWY
Practice Address - Street 2:STE. 144
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9372
Practice Address - Country:US
Practice Address - Phone:425-483-8525
Practice Address - Fax:928-223-1540
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA215199OtherL & I
WA7895 WAOtherBC / BS
WA215199OtherL & I