All Injury & Diagnostic Clinic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ALL INJURY & DIAGNOSTIC CLINIC LLC

Practice address

125 Mason Ave Ste a
Daytona Beach, FL 32117-5017

Phone

(386) 252-0658

Fax

(386) 313-0304

NPI assigned

Jan 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Johnathan Livingston Wagner, BS,DC

Title

Owner

Phone

(386) 290-2324

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546819200000",
    "number": "1932672540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MASON AVE STE A",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175017",
            "telephone_number": "386-252-0658",
            "fax_number": "386-313-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MASON AVE STE A",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175017",
            "telephone_number": "386-252-0658",
            "fax_number": "386-313-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL INJURY & DIAGNOSTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-07",
        "last_updated": "2019-01-07",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "LIVINGSTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-290-2324",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "BS,DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "247100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1881628220",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.