Provider Demographics
NPI:1134585482
Name:WAGNER, DARIN JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:DARIN
Middle Name:JOHN
Last Name:WAGNER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 ANNAPOLIS CIR N STE D
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2504
Mailing Address - Country:US
Mailing Address - Phone:612-208-2032
Mailing Address - Fax:612-567-4382
Practice Address - Street 1:2700 ANNAPOLIS CIR N STE D
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2504
Practice Address - Country:US
Practice Address - Phone:612-208-2032
Practice Address - Fax:612-567-4382
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6180OtherMN STATE LICENSE