Provider Demographics
NPI:1942334271
Name:WAGGONER, STEVEN EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:WAGGONER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:101 DEMOREST SQUARE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-6044
Mailing Address - Country:US
Mailing Address - Phone:706-776-7852
Mailing Address - Fax:706-776-0011
Practice Address - Street 1:101 DEMOREST SQUARE DR
Practice Address - Street 2:SUITE G
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-6044
Practice Address - Country:US
Practice Address - Phone:706-776-7852
Practice Address - Fax:706-776-0011
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA007483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor