Organization
TERRANCE R WAGGONER, DC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA KUNIGONIS (OFFICE MANAGER)
(574) 533-2531
Entity
Organization
Contact information
Practice address
8015 W US HIGHWAY 20, SHIPSHEWANA, IN 46565-9482
(260) 768-4333
(260) 768-4333
Mailing address
8015 W US HIGHWAY 20, SHIPSHEWANA, IN 46565-9482
(260) 768-4333
(260) 768-4333
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
51000148
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112570
—
IN
Enumeration date
11/18/2006
Last updated
08/15/2008
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