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General NPI Number Information
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NPI Number | 1164796181
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Entity Type | Organization
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Legal Business Name | ANNAPOLIS BACK & NECK CENTER, LLC
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 914 BAY RIDGE RD STE 150
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City | ANNAPOLIS
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State | MD
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Zip | 21403-3953
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Country | US
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Telephone | 410-267-0033
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Fax | 410-267-0444
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Provider Business Mailing Address
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Address Line | 914 BAY RIDGE RD STE 150
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City | ANNAPOLIS
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State | MD
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Zip | 21403-3953
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Country | US
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Telephone | 410-267-0033
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Fax | 410-267-0444
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES MICHAEL WAGNER
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Credential | D.C.
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Telephone | 410-267-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | S01457
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License Number State | MD
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