MEDICARE: DR. JAMES B. VAN WAGENEN 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	6495	TX
2	111NN1001X	Nutrition Chiropractor	DC-30427	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC-30427	OTHER	CA	CALIF. LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	TX6495	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1730196569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES B. VAN WAGENEN D.C.

Provider Business Mailing Address
First Line	:	1861 SORRELL CIR.
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95675
Country	:	US
Telephone Number	:	512-698-2602
Fax Number	:	916-725-0923

Provider Business Practice Location Address
First Line	:	6024 SAN JUAN AVE.
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-5643
Country	:	US
Telephone Number	:	916-725-7533
Fax Number	:	916-725-0923

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	09/11/2025

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