MEDICARE: DR. SANDRA WAGGENER D.C.

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	23172	CA

General Provider Information

NPI Number	:	1669663340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA WAGGENER D.C.

Provider Business Mailing Address
First Line	:	514 KAINS AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1217
Country	:	US
Telephone Number	:	510-526-2567
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 KAINS AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1217
Country	:	US
Telephone Number	:	510-526-2567
Fax Number	:	510-527-4068

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

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	11/15/2011

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Directions to “ DR. SANDRA WAGGENER D.C.” Practice Location

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