Organization
WAGNER WELLNESS LLC
Active
Other names
Rehab Lab Wisconsin
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL WAGNER DC (OWNER/LEAD DOCTOR)
(262) 344-1968
Entity
Organization
Contact information
Practice address
W3173 SPRINGFIELD DR, APPLETON, WI 54915-6183
(920) 533-0771
Mailing address
W3173 SPRINGFIELD DR, APPLETON, WI 54915-6183
(920) 533-0771
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114695186
HHS
WI
01
—
1598371668
HHS
WI
Enumeration date
10/01/2024
Last updated
10/01/2024
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