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Organization
WAGNER CHIROPRACTIC PC
Active
Organization
WAGNER CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSH D WAGNER DC (OWNER)
(507) 275-6932
Entity
Organization
Contact information
Practice address
202 S MAIN PLAZA, HENDRICKS, MN 56136-1244
(507) 275-6932
(507) 275-1212
Mailing address
1200 E 25TH ST, HIBBING, MN 55746-3897
(218) 312-3002
(218) 312-3003
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5428
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154624096
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/15/2010
Last updated
03/30/2011
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