Wagner Family Chiropractic SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4062-012 Issued in WI

Legal business name

WAGNER FAMILY CHIROPRACTIC SC

Practice address

N110 Brux Rd
Appleton, WI 54915-9439

Phone

(920) 968-0464

Fax

(920) 968-0482

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Michael Wagner, D.C.NPI 1740283183

Title

Secretary

Phone

(920) 968-0464

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Tax ID family

Wagner Family Chiropractic SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wagner Family Chiropractic SC

  • Massage Therapist
  • Appleton, WI
  • NPI 1134588288
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Ryan Wagner, D.C.

  • Chiropractor
  • Appleton, WI
  • NPI 1740283183
  Medicare reassignment Care Compare group NPD Authorized official
• Megan Elizabeth Gordley, DC

  • Chiropractor
  • Appleton, WI
  • NPI 1356333447
  Medicare reassignment Care Compare group NPD
• Antonio Lopez Jr., DC

  • Rehabilitation Chiropractor
  • Appleton, WI
  • NPI 1164291415

  WI

  Medicare reassignment Care Compare group NPD
• Jody Michelle Wagner, D.C.

  • Chiropractor
  • Appleton, WI
  • NPI 1487656799
  Medicare reassignment Care Compare group NPD
• Tami Klauer

  • Massage Therapist
  • Appleton, WI
  • NPI 1548856370
  NPD

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1295857928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N110 BRUX RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549159439",
            "telephone_number": "920-968-0464",
            "fax_number": "920-968-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N110 BRUX RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549159439",
            "telephone_number": "920-968-0464",
            "fax_number": "920-968-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER FAMILY CHIROPRACTIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "920-968-0464",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4062-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38957300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38961100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Waedekin, M.D.
• Michael L Wage, MD, PHD
• Ann Wagener, DDS
• Christopher W Wagener, MD
• Wagner Family Chiropractic SC
• Wagner Wellness LLC
• Christopher T Wagner, MD
• Courtney Lynn Wagner, LAT, ATC
• Jody Michelle Wagner, D.C.
• Kaelyn Wagner, DPT

• Chiropractor in Appleton, WI
• Providers in Appleton, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.