MEDICARE: ROBERT JOHN WAGNER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	742	MT

General Provider Information

NPI Number	:	1154413003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JOHN WAGNER DC

Provider Business Mailing Address
First Line	:	213 N HAYNES AVE
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5615
Country	:	US
Telephone Number	:	406-234-2225
Fax Number	:	406-224-3500

Provider Business Practice Location Address
First Line	:	213 N HAYNES AVE
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5615
Country	:	US
Telephone Number	:	406-234-2225
Fax Number	:	406-224-3500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/24/2014

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