Provider Demographics
NPI:1740474741
Name:WAGER, KAREN A (DC)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:WAGER
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 1:12961 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5863
Mailing Address - Country:US
Mailing Address - Phone:503-626-9311
Mailing Address - Fax:
Practice Address - Street 1:12961 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5863
Practice Address - Country:US
Practice Address - Phone:503-626-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-02
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor