Jay Frederick Wagoner, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC010942 Issued in PA

Practice address

454 Rolling Ridge Dr
Suite 4
State College, PA 16801-7696

Phone

(814) 954-4182

NPI assigned

Dec 11, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Summit Chiropractic Clinic

  • Chiropractor
  • State College, PA
  • NPI 1285798710
  NPD

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

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1952709693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 ROLLING RIDGE DR",
            "address_2": "SUITE 4",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017696",
            "telephone_number": "814-954-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 ROLLING RIDGE DR",
            "address_2": "SUITE 4",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017696",
            "telephone_number": "814-954-4182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JAY",
        "middle_name": "FREDERICK",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-11",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC010942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilbur Lewis Wadlington, PH.D.
• Allison Wagner
• Ashley E Wagner, CRNP
• Matthew F. Wagner, LPC
• Wagoner Chiropractic Inc
• Kayla Ellen Wagoner, D.C.
• Caryl L. Waite, PA-C
• Megan Waite, DNP, FNP-C
• Wal-Mart Stores East , LP
• Wal-Mart Stores East LP

• Chiropractor in State College, PA
• Providers in State College, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.