Individual
JAMES M WAGNER
Active
Individual
JAMES M WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
1457/PT
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M155
BCBS
MD
01
—
W2090001
BCBS FEP
MD
Enumeration date
11/01/2006
Last updated
01/08/2013
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