MEDICARE: DR. DONALD WAGNER D.C.

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	DC005629L	PA

General Provider Information

NPI Number	:	1376540989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD WAGNER D.C.

Provider Business Mailing Address
First Line	:	10 COPPERFIELD CIR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-9481
Country	:	US
Telephone Number	:	717-627-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 COPPERFIELD CIR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-9481
Country	:	US
Telephone Number	:	717-627-0818
Fax Number	:

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/08/2007

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