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General NPI Number Information
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NPI Number | 1760028054
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Entity Type | Individual
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Provider Name | PAMELA JEAN WASKE DC
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Gender | Female
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 3123 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-2303
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Country | US
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Telephone | 815-236-5747
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Fax |
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Provider Business Mailing Address
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Address Line | 4977 OLEATHA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-1224
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Country | US
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Telephone | 815-236-5747
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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 | 2019030703
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License Number State | MO
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