MEDICARE: DR. SCOTT WADDELL 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	DC22884	CA

General Provider Information

NPI Number	:	1912045840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT WADDELL D.C.

Provider Business Mailing Address
First Line	:	4855 ATHERTON AVE STE 204
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1026
Country	:	US
Telephone Number	:	408-871-9355
Fax Number	:	408-871-8511

Provider Business Practice Location Address
First Line	:	4855 ATHERTON AVE STE 204
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1026
Country	:	US
Telephone Number	:	408-871-9355
Fax Number	:	408-871-8511

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	03/13/2008

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