Gerrit Lee Wagner, D.C., L.AC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC33062 Issued in CA

Practice address

620 Alabama St
Redlands, CA 92373-8059

Phone

(909) 792-4434

Fax

(909) 335-1139

NPI assigned

Sep 17, 2014

Sex

Male

Sole proprietor

Yes

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 CA

Enrollment records 1

Specialty

Chiropractic

Education

Los Angeles College of Chiropractic, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Phillips-White Chiropractic CorporationGroup PAC ID 7719170687, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Phillips-White Chiropractic Corporation

  • Chiropractor
  • Redlands, CA
  • NPI 1336265362
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425340800000",
    "number": "1720480189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 ALABAMA ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738059",
            "telephone_number": "909-792-4434",
            "fax_number": "909-335-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 ALABAMA ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738059",
            "telephone_number": "909-792-4434",
            "fax_number": "909-335-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GERRIT",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.C., L.AC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-17",
        "last_updated": "2015-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC33062",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC16183",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Volkov, RN
• Tom Vu, MS
• Christopher Eric Wacker, DDS
• Clare Aurora Wada, DO
• Jonathan Waggonner, PTA, CMT
• Stephanie Waidner
• Shannon Harris Wailes, DDS
• Wal-Mart Stores, Inc.
• Walgreen Co
• Rajeev Walia, MD

• Chiropractor in Redlands, CA
• Providers in Redlands, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.