Active NPI
Samuel Wagner, DC
- Chiropractor
- Green Bay, WI
National Provider Identifier
1114695186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5680-12
- Practice address
- 2525 W Mason St
Green Bay, WI 54303-4838 - Phone
- (920) 429-2844
- NPI assigned
- Sep 2, 2021
- Last updated
- Sep 2, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5680-12 | WI | Primary |
Addresses
Primary practice location
2525 W Mason St
Green Bay, WI 54303-4838
Mailing address
2525 W Mason St
Green Bay, WI 54303-4838
Phone (920) 429-2844
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5680-12 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wagner Wellness LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630540800000",
"number": "1114695186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 W MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543034838",
"telephone_number": "920-429-2844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 W MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543034838",
"telephone_number": "920-429-2844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "SAMUEL",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-02",
"last_updated": "2021-09-02",
"certification_date": "2021-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "5680-12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.