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General NPI Number Information
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NPI Number | 1326717216
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Entity Type | Individual
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Provider Name | JOSHUA RYAN WASCHAK DC
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Gender | Male
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 2821 N BALLAS RD STE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2314
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Country | US
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Telephone | 314-872-9955
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Fax |
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Provider Business Mailing Address
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Address Line | 16604 MARCROSS CT
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City | CHESTERFIELD
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State | MO
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Zip | 63005-4826
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Country | US
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Telephone | 661-289-2339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 20211036408
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License Number State | MO
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