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NPI Code Detail

MEDICARE: DR. JODY MICHELLE WAGNER D.C.

MEDICARE: DR. JODY MICHELLE 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
1111N00000XChiropractor4062-012WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487656799
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JODY MICHELLE WAGNER D.C.
Provider Business Mailing Address
First Line : N110 BRUX RD
Second Line :
City : APPLETON
State : WI
Zip : 54915-9439
Country : US
Telephone Number : 920-968-0464
Fax Number : 920-968-0482
Provider Business Practice Location Address
First Line : N110 BRUX RD
Second Line :
City : APPLETON
State : WI
Zip : 54915-9439
Country : US
Telephone Number : 920-968-0464
Fax Number : 920-968-0482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 06/11/2024

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