Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3170 | OK |
NPI | 1013015064 |
---|---|
Provider Name | Dr. David Bo Waggoner |
First Address | Oklahoma City, OK 73132-3514 |
Second Address | Oklahoma City, OK 73132-3514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |