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General NPI Number Information
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NPI Number | 1942398706
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Entity Type | Individual
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Provider Name | LISA ANN WAGNER D.C.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 625 E ARROW HWY SUITE 2
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City | GLENDORA
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State | CA
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Zip | 91740-6521
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Country | US
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Telephone | 626-852-2822
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Fax | 626-852-2824
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Provider Business Mailing Address
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Address Line | 625 E. ARROW HIGHWAY SUITE 2
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City | GLENDORA
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State | CA
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Zip | 91740-6090
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Country | US
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Telephone | 626-852-2822
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Fax | 626-852-2824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC23398
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License Number State | CA
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