Wagoner Holdings PA

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

WAGONER HOLDINGS PA

Doing business as

Wake Forest Chiropractic

Practice address

851 Wake Forest Business Park Ste E
Wake Forest, NC 27587-7366

Phone

(260) 573-1249

NPI assigned

Oct 19, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Evan Jonathon Wagoner, DCNPI 1710507488

Title

Owner

Phone

(260) 573-1249

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wake Forest Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

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

• Evan Jonathon Wagoner, DC

  • Chiropractor
  • Wake Forest, NC
  • NPI 1710507488
  Medicare reassignment NPD Authorized official
• Shawn P Phelan, D.O.

  • Chiropractor
  • Wake Forest, NC
  • NPI 1740275072
  NPD

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

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1679236400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 WOODLAND HILLS TRL APT 204",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275871778",
            "telephone_number": "260-573-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 WAKE FOREST BUSINESS PARK STE E",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877366",
            "telephone_number": "260-573-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER HOLDINGS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-19",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "EVAN",
        "authorized_official_middle_name": "JONATHON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-573-1249",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC STATE CHIROPRACTIC LICENSE NUMBER",
            "identifier": "5176",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wake Forest Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Vrooman, AU.D
• W E B Dubois CDC
• W.E.B. Dubois Community Development Corporation
• Charles Wade
• Joanne E Wagner, MD
• Eric James Wagoner, DDS
• Evan Jonathon Wagoner, DC
• Androu Wahba, DPT
• Wake Audiology & Hearing Aid Associates, PLLC
• Wake County Psychological Services, Inc.

• Health Service Clinic/Center in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Health Service Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.