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General NPI Number Information
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NPI Number | 1366616757
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Entity Type | Organization
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Legal Business Name | WAGNER FAMILY CHIROPRACTIC CENTER, PS
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 9615 LEVIN RD NW SUITE 100
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City | SILVERDALE
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State | WA
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Zip | 98383-7666
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Country | US
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Telephone | 360-692-3800
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Fax | 360-692-3700
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Provider Business Mailing Address
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Address Line | 9615 LEVIN RD NW SUITE 100
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City | SILVERDALE
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State | WA
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Zip | 98383-7666
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Country | US
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Telephone | 360-692-3800
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Fax | 360-692-3700
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. MICHAEL WAGNER
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Credential | D.C.
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Telephone | 360-692-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00003618
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License Number State | WA
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