Trevor John Wagner, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

1125 Issued in NE

Practice address

2639 S 159TH PLZ
Omaha, NE 68130-1705

Phone

(402) 334-4700

Fax

(402) 334-0891

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Chiropractic

Education

Cleveland Chiropractic College - Kansas City, 1995

Medicare assignment

May accept Medicare assignment

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.

• Wagner Chiropractic Clinic, PC

  • Chiropractor
  • Omaha, NE
  • NPI 1801982806
  NPD Authorized official

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740229566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6411 S 172ND AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681353080",
            "telephone_number": "402-891-1249",
            "fax_number": "402-334-0891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2639 S 159TH PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681301705",
            "telephone_number": "402-334-4700",
            "fax_number": "402-334-0891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TREVOR",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NE",
            "license": "1125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "36615",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47-0802260 05",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Wagner
• Regina A. Wagner, APRN-DNP
• Regina L Wagner
• Stephanie Marie Wagner, PLMHP
• Tina Michelle Wagner
• Vance N Wagner, PHARM.D.
• Jill Wagoner, M.D.
• Kimberley Wagoner
• Sarah Wagstaff
• Ba Blue Wah

• Sports Physician Chiropractor in Omaha, NE
• Providers in Omaha, NE by specialty
• Sports Physician Chiropractor in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.