Active NPI
Shaeli Waggoner, D.C.
- Chiropractor
- Woodridge, IL
National Provider Identifier
1194004689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038010540
- Practice address
- 6830 Juneberry Ave
Woodridge, IL 60517-1707 - Phone
- (563) 320-5670
- NPI assigned
- Aug 15, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038010540 | IL | Primary |
Addresses
Primary practice location
6830 Juneberry Ave
Woodridge, IL 60517-1707
Mailing address
6830 Juneberry Ave
Woodridge, IL 60517-1707
Phone (563) 320-5670
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120125000348 | IL | Practitioner - Chiropractic | 5597932913 | Practice locations: Oak Lawn, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
10220 S Cicero Ave
Suite 102
Oak Lawn, IL 60453-4086
Phone (630) 557-6040
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313366400000",
"number": "1194004689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6830 JUNEBERRY AVE",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605171707",
"telephone_number": "563-320-5670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6830 JUNEBERRY AVE",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605171707",
"telephone_number": "563-320-5670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "SHAELI",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-15",
"last_updated": "2011-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038010540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.