Terrance R Waggoner, DC
Individual provider Active NPI Chiropractor · Shipshewana, IN
NPI 1811993009 · NPPES record last updated Aug 21, 2008
Key facts
- NPI
- 1811993009
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 08001068A (IN)
- Practice address
- 8015 W US Highway 20
Shipshewana, IN 46565-9482 - Phone
- (260) 768-4333
- Fax
- (260) 768-4333
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 1986
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Garber Chiropractic Inc
Practice addresses (Care Compare)
660 A S Van Buren St
Shipshewana, IN 46565-9098
Phone (260) 768-4333
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091222000174 | IN | Practitioner - Chiropractic | 2961441498 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08001068A | IN | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garber Chiropractic, Inc. | Chiropractor | Current |
Accepting new patients |
Locations
660A S Van Buren St
Shipshewana, IN 46565
Phone (260) 768-4333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 08001068A | IN | Yes |
Addresses
Primary practice location
8015 W US Highway 20
Shipshewana, IN 46565-9482
Mailing address
8015 W US Highway 20
Shipshewana, IN 46565-9482
Phone (260) 768-4333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350055622 | Other | IN | RR/TRAVELERS MEDICARE |
| 100113980A | Medicaid | IN |
Other providers in Shipshewana, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.