Provider Demographics
NPI:1649218371
Name:WANGERIN, TONY PRESTON (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:PRESTON
Last Name:WANGERIN
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 1:11800 SINGLETREE LN
Mailing Address - Street 2:SUITE 310
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5328
Mailing Address - Country:US
Mailing Address - Phone:952-412-1880
Mailing Address - Fax:952-223-4027
Practice Address - Street 1:11800 SINGLETREE LN
Practice Address - Street 2:SUITE 310
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5328
Practice Address - Country:US
Practice Address - Phone:952-412-1880
Practice Address - Fax:952-223-4027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor