Healthcare Provider Details

I. General information

NPI: 1558274449
Provider Name (Legal Business Name): VICTORIA WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SAGE CREEK WAY
GREER SC
29650-0957
US

IV. Provider business mailing address

3014 HUNTERS BROOK DR
BOILING SPRINGS SC
29316-5179
US

V. Phone/Fax

Practice location:
  • Phone: 864-848-0640
  • Fax:
Mailing address:
  • Phone: 864-848-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5122
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: