Active NPI
Timothy John Wagner, D.C., B.S.
- Chiropractor
- Appleton, WI
National Provider Identifier
1215923156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4002-012
- Practice address
- 118 N Durkee St
Appleton, WI 54911-5427 - Phone
- (920) 830-2225
- Fax
- (920) 830-2221
- NPI assigned
- Sep 26, 2005
- Reactivated
- Apr 5, 2006
- Last updated
- Jul 13, 2026
- 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 | 4002-012 | WI | Primary |
Addresses
Primary practice location
118 N Durkee St
Appleton, WI 54911-5427
Mailing address
118 N Durkee St
Appleton, WI 54911-5427
Phone (920) 830-2225
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4002-012 | WI | MD | Chiropractor |
| 4002 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1215923156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 N DURKEE ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549115427",
"telephone_number": "920-830-2225",
"fax_number": "920-830-2221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 N DURKEE ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549115427",
"telephone_number": "920-830-2225",
"fax_number": "920-830-2221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.C., B.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-26",
"last_updated": "2026-07-13",
"deactivation_date": "2006-03-24",
"reactivation_date": "2006-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "4002-012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
- Jody Michelle Wagner, D.C.
- Kaelyn Wagner, DPT
- Keith Dineen Wagner, M.D.
- Michael Ryan Wagner, D.C.
- Ryan J Wagner
- Wal-Mart Stores Easst, LP (Vision Center 30-2958)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1982)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2958)
- Wal-Mart Stores East, LP (Vision Center 30-1982)
- Connie Mary Walbrun, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.