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Individual

TERRANCE R WAGGONER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DC

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
08001068A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100113980A
IN
01
350055622
RR/TRAVELERS MEDICARE
IN
Enumeration date
06/22/2005
Last updated
08/21/2008
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