Provider Demographics
NPI:1487629028
Name:WAGER, SCOTT CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:WAGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 CAPE HORN RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9057
Mailing Address - Country:US
Mailing Address - Phone:717-840-0888
Mailing Address - Fax:717-840-4369
Practice Address - Street 1:2555 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9057
Practice Address - Country:US
Practice Address - Phone:717-840-0888
Practice Address - Fax:717-840-4369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006112-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWA632039Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAU55138Medicare UPIN