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General NPI Number Information
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NPI Number | 1902074966
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Entity Type | Organization
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Legal Business Name | WAGNER CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 213 N HAYNES
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City | MILES CITY
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State | MT
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Zip | 59301
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Country | US
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Telephone | 406-234-2225
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Fax | 406-234-3500
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Provider Business Mailing Address
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Address Line | 213 N HAYNES
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City | MILES CITY
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State | MT
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Zip | 59301
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Country | US
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Telephone | 406-234-2225
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Fax | 406-234-3500
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT J WAGNER
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Credential | D.C.
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Telephone | 406-951-1199
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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 | 742
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License Number State | MT
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