Evan Jonathon Wagoner, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5176 Issued in NC

Practice address

1408 Woodland Hills TRL
Apt 204
Wake Forest, NC 27587-1778

Phone

(260) 573-1249

NPI assigned

Apr 22, 2020

Last updated

Oct 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Chiropractic

Education

Sherman College of Straight Chiropractic, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Smithfield Chiropractic PLLC

  • Chiropractor
  • Smithfield, NC
  • NPI 1427911981
  Medicare reassignment NPD Authorized official
• Wagoner Holdings PA

  dba Wake Forest Chiropractic

  • Health Service Clinic/Center
  • Wake Forest, NC
  • NPI 1679236400
  Medicare reassignment NPD Authorized official
• Wake Forest Chiropractic, PA

  • Chiropractor
  • Wake Forest, NC
  • NPI 1720158199
  NPD

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1710507488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 WOODLAND HILLS TRL",
            "address_2": "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": "1408 WOODLAND HILLS TRL",
            "address_2": "APT 204",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275871778",
            "telephone_number": "260-573-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "EVAN",
        "middle_name": "JONATHON",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-22",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "5176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W.E.B. Dubois Community Development Corporation
• Charles Wade
• Joanne E Wagner, MD
• Wagoner Holdings PA (Wake Forest Chiropractic)
• Eric James Wagoner, DDS
• Androu Wahba, DPT
• Wake Audiology & Hearing Aid Associates, PLLC
• Wake County Psychological Services, Inc.
• Wake Family Chiropractic PA
• Wake Foot and Ankle Center PLLC

• Chiropractor in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.