Healthcare Provider Details

I. General information

NPI: 1508799438
Provider Name (Legal Business Name): JOSHUA WAGNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 DAVIS BLVD STE 101
NAPLES FL
34104-4369
US

IV. Provider business mailing address

2800 DAVIS BLVD STE 101
NAPLES FL
34104-4369
US

V. Phone/Fax

Practice location:
  • Phone: 239-269-6919
  • Fax:
Mailing address:
  • Phone: 239-269-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: