Provider Demographics
NPI:1376651075
Name:WAGNER, DANIEL J (D C)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 DE LA VINA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3372
Mailing Address - Country:US
Mailing Address - Phone:805-682-2407
Mailing Address - Fax:805-569-5673
Practice Address - Street 1:2922 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3372
Practice Address - Country:US
Practice Address - Phone:805-682-2407
Practice Address - Fax:805-569-5673
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor