Jeremy M Wagnon, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4838-12 Issued in WI

Practice address

615 Pennsylvania Ave
Sheboygan, WI 53081-4642

Phone

(404) 754-6779

NPI assigned

Feb 2, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Strickland Family Chiropractic PAGroup PAC ID 3072777846, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Strickland Family Chiropractic, PA

  • Chiropractor
  • Meridian, ID
  • NPI 1841378957
  Medicare reassignment Care Compare group
• Olsen Chiropractic and Performance Enhancement

  • Chiropractor
  • Nampa, ID
  • NPI 1912221938
  NPD

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341532800000",
    "number": "1679879050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 PENNSYLVANIA AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530814642",
            "telephone_number": "404-754-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 PENNSYLVANIA AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530814642",
            "telephone_number": "404-754-6779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNON",
        "first_name": "JEREMY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-02",
        "last_updated": "2012-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008777",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4838-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Wachowiak, COTA
• Jessica Ann Wagner, OTR/L
• Jodi Lynn Wagner, OTR
• Lindsay Nicole Wagner, RN
• William G Wagner, MD
• Justin Dean Wahl Adame, SAC-IT
• Wal-Mart Stores East LP (Wal-Mart Vision Center 30-1276)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1276)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-3324)
• Amanda M Walesh, COTA, CLT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.