Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2257 | CO |
NPI | 1184762064 |
---|---|
Provider Name | Dr. Clinton C Waggoner Ch |
First Address | Colorado Springs, CO 80907-6375 |
Second Address | Colorado Springs, CO 80907-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 26/06/2008 |