MEDICARE: DR. DAVID SCOTT 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	28195	CA
2	111N00000X	Chiropractor	B01987	NV

General Provider Information

NPI Number	:	1508847997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SCOTT WAGNER D.C.

Provider Business Mailing Address
First Line	:	2440 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2731
Country	:	US
Telephone Number	:	702-798-7171
Fax Number	:	702-436-6561

Provider Business Practice Location Address
First Line	:	2440 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2731
Country	:	US
Telephone Number	:	702-798-7171
Fax Number	:	702-436-6561

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	05/29/2024

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