Wagner Family Wellness Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00003095 Issued in WA

Legal business name

WAGNER FAMILY WELLNESS CENTER LLC

Practice address

21505 Market PL NW
Suite 102
Poulsbo, WA 98370-6635

Phone

(360) 598-3143

Fax

(360) 598-4172

NPI assigned

Mar 25, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Blake Joseph Wagner, D.C.

Title

Member/Manager

Phone

(360) 598-3143

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1301011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1629377940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21505 MARKET PL NW",
            "address_2": "SUITE 102",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706635",
            "telephone_number": "360-598-3143",
            "fax_number": "360-598-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21505 MARKET PL NW",
            "address_2": "SUITE 102",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706635",
            "telephone_number": "360-598-3143",
            "fax_number": "360-598-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER FAMILY WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-25",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "360-598-3143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah E Verdugo, LICSW, LCSW, SUDP
• Vintage Direct Primary Care
• Virginia E Swanson MD PLLC
• Shannon Foster Vitone
• Matthew A Voorsanger, MD
• Blake Joseph Wagner, D.C.
• Wal-Mart Stores, Inc
• Robert Livingston Walker, LMHC
• Kristin Waller, RPH
• Walmart Inc.

• Chiropractor in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.