Provider Demographics
NPI:1568860401
Name:WAGNER, ANDREW ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ANTHONY
Last Name:WAGNER
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 1:16 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1904
Mailing Address - Country:US
Mailing Address - Phone:406-665-9015
Mailing Address - Fax:406-665-4078
Practice Address - Street 1:16 3RD ST W
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1904
Practice Address - Country:US
Practice Address - Phone:406-665-9015
Practice Address - Fax:406-665-4078
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-3436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor