Active NPI
John Ben Van Wagner, D.C.
- Chiropractor
- Great Barrington, MA
National Provider Identifier
1962586305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2279
- Practice address
- 80 Maple Ave
Ste. 6
Great Barrington, MA 01230-1948 - Phone
- (413) 644-8989
- Fax
- (413) 644-9300
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2279 | MA | Primary |
Addresses
Primary practice location
80 Maple Ave
Ste. 6
Great Barrington, MA 01230-1948
Mailing address
531 Main St
Great Barrington, MA 01230-2001
Phone (413) 644-8989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2279 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584057600000",
"number": "1962586305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "531 MAIN ST",
"city": "GREAT BARRINGTON",
"state": "MA",
"postal_code": "012302001",
"telephone_number": "413-644-8989",
"fax_number": "413-644-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 MAPLE AVE",
"address_2": "STE. 6",
"city": "GREAT BARRINGTON",
"state": "MA",
"postal_code": "012301948",
"telephone_number": "413-644-8989",
"fax_number": "413-644-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WAGNER",
"first_name": "JOHN",
"middle_name": "BEN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2020-03-13",
"certification_date": "2020-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MA",
"license": "2279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Barrington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.