Healthcare Provider Details

I. General information

NPI: 1750406724
Provider Name (Legal Business Name): CHUNG & WAGGONER HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 NW EXPRESSWAY ST SUITE H
OKLAHOMA CITY OK
73132-3514
US

IV. Provider business mailing address

7000 NW EXPRESSWAY ST SUITE H
OKLAHOMA CITY OK
73132-3514
US

V. Phone/Fax

Practice location:
  • Phone: 405-773-1113
  • Fax: 405-773-1114
Mailing address:
  • Phone: 405-773-1113
  • Fax: 405-773-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3170
License Number StateOK

VIII. Authorized Official

Name: DR. DAVID B. WAGGONER
Title or Position: CEO
Credential: D.C.
Phone: 405-773-1113