MEDICARE: WAGERS CHIROPRACTIC CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1095	SC

General Provider Information

NPI Number	:	1023293743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAGERS CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	1037 W DEKALB ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-4162
Country	:	US
Telephone Number	:	803-432-0464
Fax Number	:	803-432-3143

Provider Business Practice Location Address
First Line	:	1037 W DEKALB ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-4162
Country	:	US
Telephone Number	:	803-432-0464
Fax Number	:	803-432-3143

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. WILLIAM LEE WAGERS
Credential	:	D.C
Telephone Number	:	803-432-0464

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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