Provider Demographics
NPI:1508847997
Name:WAGNER, DAVID SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:WAGNER
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 1:2440 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2731
Mailing Address - Country:US
Mailing Address - Phone:702-798-7171
Mailing Address - Fax:702-436-6561
Practice Address - Street 1:2440 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2731
Practice Address - Country:US
Practice Address - Phone:702-798-7171
Practice Address - Fax:702-436-6561
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28195111N00000X
NVB01987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88885Medicare UPIN
CADC0281950Medicare ID - Type Unspecified