NPIMap

Organization Active NPI

Wagner Chiropractic PC

  • Chiropractor
  • Hendricks, MN
National Provider Identifier
1154624096
Registry record updated Mar 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5428 Issued in MN
Legal business name
WAGNER CHIROPRACTIC PC
Practice address
202 S Main Plaza
Hendricks, MN 56136-1244
Phone
(507) 275-6932
Fax
(507) 275-1212
NPI assigned
Dec 15, 2010
Last updated
Mar 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Josh D Wagner, DC
Title
Owner
Phone
(507) 275-6932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5428 MN Primary

Addresses

Primary practice location

202 S Main Plaza
Hendricks, MN 56136-1244

Mailing address

1200 E 25TH St
Hibbing, MN 55746-3897
Phone (218) 312-3002

Other identifiers 1

IdentifierTypeStateIssuer
1154624096OtherMNBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1154624096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E 25TH ST",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557463897",
            "telephone_number": "218-312-3002",
            "fax_number": "218-312-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S MAIN PLAZA",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561361244",
            "telephone_number": "507-275-6932",
            "fax_number": "507-275-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2011-03-30",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JOSH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-275-6932",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1154624096",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendricks, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.