Provider Demographics
NPI:1174745145
Name:WADDELL, JASON KENT (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:KENT
Last Name:WADDELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23724 51ST CT S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3300
Mailing Address - Country:US
Mailing Address - Phone:636-236-1278
Mailing Address - Fax:
Practice Address - Street 1:26238 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6934
Practice Address - Country:US
Practice Address - Phone:253-529-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor