NPIMap

Organization Active NPI

Lafayette Chiropractic LLC

Doing business as Wagner Chiropractic Center

  • Chiropractor
  • Lafayette, IN
National Provider Identifier
1942479423
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
LAFAYETTE CHIROPRACTIC LLC
Doing business as
Wagner Chiropractic Center
Practice address
3778 Union St
Lafayette, IN 47905-4453
Phone
(765) 448-1674
Fax
(765) 449-0847
NPI assigned
Feb 28, 2008
Last updated
Oct 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
David Alan Bowman, DCNPI 1407264039
Title
Owner
Phone
(765) 448-1674

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 IN Primary

Addresses

Primary practice location

3778 Union St
Lafayette, IN 47905-4453

Mailing address

3778 Union St
Lafayette, IN 47905-4453
Phone (765) 448-1674

Other identifiers 2

IdentifierTypeStateIssuer
200925750 AMedicaidIN
256900OtherINMEDICARE PTAN

Other names 1

  • Wagner Chiropractic Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221130001882 IN Part B Supplier - Clinic/Group Practice 5193193852 Receives reassigned benefits from 2 practitioners
Practice locations: Lafayette, IN

National Provider Directory

National Provider Directory
Tax ID family
Lafayette Chiropractic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1942479423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3778 UNION ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054453",
            "telephone_number": "765-448-1674",
            "fax_number": "765-449-0847"
        },
        {
            "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",
            "fax_number": "765-449-0847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAFAYETTE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-448-1674",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200925750 A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "256900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagner Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.