NPIMap

Organization Active NPI

Wagner Chiropractic Clinic, PC

Doing business as West Omaha Chiropractic & Sports Injury Clinic

  • Chiropractor
  • Omaha, NE
National Provider Identifier
1801982806
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1124 Issued in NE
Legal business name
WAGNER CHIROPRACTIC CLINIC, PC
Doing business as
West Omaha Chiropractic & Sports Injury Clinic
Practice address
2639 S 159TH PLZ
Omaha, NE 68130-1705
Phone
(402) 334-4700
Fax
(402) 334-0891
NPI assigned
Oct 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Trevor John Wagner, D.C.NPI 1740229566
Title
VP
Phone
(402) 334-4700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1124 NE Primary

Addresses

Primary practice location

2639 S 159TH PLZ
Omaha, NE 68130-1705

Mailing address

2639 S 159TH PLZ
Omaha, NE 68130-1705
Phone (402) 334-4700

Other identifiers 2

IdentifierTypeStateIssuer
36615OtherNEBLUE CROSS FOR T WAGNER
36614OtherNEBLUE CROSS FOR J OWEN-WAG

Other names 1

  • West Omaha Chiropractic & Sports Injury Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050221000470 NE Part B Supplier - Clinic/Group Practice 2264484047 Receives reassigned benefits from 1 practitioner
Practice locations: Omaha, NE

National Provider Directory

National Provider Directory

Locations

2639 S 159th Plz
Omaha, NE 68130
Phone (402) 334-4700

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801982806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "WAGNER CHIROPRACTIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "402-334-4700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FOR T WAGNER",
            "identifier": "36615",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FOR J OWEN-WAG",
            "identifier": "36614",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Omaha Chiropractic & Sports Injury Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.