Provider Demographics
NPI:1316928005
Name:WADDELL, RANI HEATHER (DC)
Entity type:Individual
Prefix:DR
First Name:RANI
Middle Name:HEATHER
Last Name:WADDELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 FOX RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7691
Mailing Address - Country:US
Mailing Address - Phone:717-926-1166
Mailing Address - Fax:717-272-2326
Practice Address - Street 1:456 E CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8118
Practice Address - Country:US
Practice Address - Phone:717-926-1166
Practice Address - Fax:717-272-2326
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWA1604188OtherBLUE SHIELD
PA50037855OtherBLUE CROSS
PA50037855OtherBLUE CROSS
PAV00039Medicare UPIN