Provider Demographics
NPI:1013942945
Name:WAGLE, SUNJAY S (DC)
Entity Type:Individual
Prefix:
First Name:SUNJAY
Middle Name:S
Last Name:WAGLE
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:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:469-727-7246
Mailing Address - Fax:469-727-7833
Practice Address - Street 1:951 YORK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2052
Practice Address - Country:US
Practice Address - Phone:469-727-7246
Practice Address - Fax:469-727-7833
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198851101Medicaid
TX198851103Medicaid
TX198851102Medicaid
U86997Medicare UPIN
TX8L5667Medicare PIN
TX8L5465Medicare PIN
TX198851101Medicaid