Provider Demographics
NPI:1831105758
Name:WAGNER, ADAM BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:BRIAN
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 1:751 E UNION HILLS DR
Mailing Address - Street 2:#7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2978
Mailing Address - Country:US
Mailing Address - Phone:602-787-9511
Mailing Address - Fax:602-787-9511
Practice Address - Street 1:751 E UNION HILLS DR
Practice Address - Street 2:#7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-2978
Practice Address - Country:US
Practice Address - Phone:602-787-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5541111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ116237Medicare PIN
AZZ116238Medicare PIN