MEDICARE: WAGNER CHIROPRACTIC CLINIC P.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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1679623391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAGNER CHIROPRACTIC CLINIC P.C.

Provider Business Mailing Address
First Line	:	9227 N OAK TRFY
Second Line	:	SUITE 101
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3392
Country	:	US
Telephone Number	:	816-420-3072
Fax Number	:	816-420-3077

Provider Business Practice Location Address
First Line	:	9227 N OAK TRFY
Second Line	:	SUITE 101
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3392
Country	:	US
Telephone Number	:	816-420-3072
Fax Number	:	816-420-3077

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHIAS HEINRICH WAGNER
Credential	:	D.C.
Telephone Number	:	816-420-3072

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/06/2009

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