Brandon James Wagner, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

08003257A Issued in IN

Practice address

3778 Union St
Lafayette, IN 47905-4453

Phone

(765) 448-1674

NPI assigned

Sep 22, 2021

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 IN

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Pure Life Chiropractic, LLC

  • Chiropractor
  • Zionsville, IN
  • NPI 1699428185
  Medicare reassignment NPD
• Lafayette Chiropractic LLC

  • Chiropractor
  • Lafayette, IN
  • NPI 1912622093
  NPD
• Lafayette Chiropractic LLC

  • Chiropractor
  • Lafayette, IN
  • NPI 1942479423
  NPD

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1801567524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6504 AMHERST WAY",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460779138",
            "telephone_number": "765-412-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3778 UNION ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054453",
            "telephone_number": "765-448-1674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRANDON",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-22",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08003257A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wabash Center, Inc.
• Wabash Center, Inc.
• Wabash Center, Inc.
• Wabash Center, Inc.
• Jacob Wade, NP
• John S Wagner, D.C.
• Julia Marie Wagner, D.C.
• Theodore T Wagner III, MD
• Britney Wagoner
• Elizabeth Wagoner

• Chiropractor in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.