Michelle K Waggoner, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

71 3666 Issued in OR

Practice address

501 NE Hood Ave, Ste 205
Gresham, OR 97030

Phone

(503) 674-7894

Fax

(503) 674-7899

NPI assigned

Jan 22, 2007

Last updated

Feb 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Active Family Chiropractic, LLC

  dba Active Family Chiropractic

  • Sports Physician Chiropractor
  • Gresham, OR
  • NPI 1104221530
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1316091275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 NE HOOD AVE, STE 205",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "503-674-7894",
            "fax_number": "503-674-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 NE HOOD AVE, STE 205",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "503-674-7894",
            "fax_number": "503-674-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "MICHELLE",
        "middle_name": "K",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "71 3666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W2 Powell Valley, LLC (Powell Valley Assisted Living Community)
• Georgianna Wade, LMT
• Michael Dean Wade, MS, LMT
• Shyra Q Wade, CSWA/QMHA-I
• Brian Wadyka, PHARM.D.
• Shaylene Tamara Waggoner, BSN, RN
• Andrew Wagner
• Samantha Wagner
• Wendy Waibel, FNP
• Ryleigh Wainwright

• Chiropractor in Gresham, OR
• Providers in Gresham, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.