Healthcare Provider Details

I. General information

NPI: 1679623391
Provider Name (Legal Business Name): WAGNER CHIROPRACTIC CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9227 N OAK TRFY SUITE 101
KANSAS CITY MO
64155-3392
US

IV. Provider business mailing address

9227 N OAK TRFY SUITE 101
KANSAS CITY MO
64155-3392
US

V. Phone/Fax

Practice location:
  • Phone: 816-420-3072
  • Fax: 816-420-3077
Mailing address:
  • Phone: 816-420-3072
  • Fax: 816-420-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHIAS HEINRICH WAGNER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 816-420-3072