MEDICARE: DR. JAMES STEVEN WADDELL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4436	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085S008	OTHER	MO	AETNA
2	167788016	OTHER	MO	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043245384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES STEVEN WADDELL DC

Provider Business Mailing Address
First Line	:	6716 NORTH OAK TRAFFICWAY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-3345
Country	:	US
Telephone Number	:	816-436-7153
Fax Number	:	816-436-7158

Provider Business Practice Location Address
First Line	:	6716 NORTH OAK TRAFFICWAY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-3345
Country	:	US
Telephone Number	:	816-436-7153
Fax Number	:	816-436-7158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/05/2010

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