Provider Demographics
NPI:1982855888
Name:WAGNER, ASHLEY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LYNN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 SHELBURNE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5677
Mailing Address - Country:US
Mailing Address - Phone:701-557-7455
Mailing Address - Fax:
Practice Address - Street 1:4719 SHELBURNE ST STE 2
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5677
Practice Address - Country:US
Practice Address - Phone:701-557-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND830111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor