Individual
DR. MITCHELL JOHN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
34 13TH AVE NE STE B002C, MINNEAPOLIS, MN 55413-1091
(612) 879-8000
Mailing address
34 13TH AVE NE STE B002C, MINNEAPOLIS, MN 55413-1091
(612) 879-8000
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6461
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6461
N/A
MN
Enumeration date
09/18/2018
Last updated
09/18/2018
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