Physician Compare National (NPI:1245659507)

HEALTHCARE PROVIDER: BURTON WAGNER D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1245659507
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901128164
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141209000734
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAGNER
	Individual professional last name
Provider First Name	BURTON
	Individual professional first name
Provider Middle Name	LELAND
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LIFE CHIROPRACTIC COLLEGE - WEST
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	647 CAMINO DE LOS MARES
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 218
	Group Practice or individual's line 2 address
City	SAN CLEMENTE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	926732807
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y