Provider Demographics
NPI:1679623391
Name:WAGNER CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:WAGNER CHIROPRACTIC CLINIC P.C.
Other - Org Name:WAGNER WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:HEINRICH
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-420-3072
Mailing Address - Street 1:9227 N OAK TRFY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-3392
Mailing Address - Country:US
Mailing Address - Phone:816-420-3072
Mailing Address - Fax:816-420-3077
Practice Address - Street 1:9227 N OAK TRFY
Practice Address - Street 2:SUITE 101
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-3392
Practice Address - Country:US
Practice Address - Phone:816-420-3072
Practice Address - Fax:816-420-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266661Medicare Oscar/Certification