MEDICARE: DR. DANIEL J WAGNER D. C.

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	15064	CA

General Provider Information

NPI Number	:	1376651075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL J WAGNER D. C.

Provider Business Mailing Address
First Line	:	2922 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3372
Country	:	US
Telephone Number	:	805-682-2407
Fax Number	:	805-569-5673

Provider Business Practice Location Address
First Line	:	2922 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3372
Country	:	US
Telephone Number	:	805-682-2407
Fax Number	:	805-569-5673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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