Individual
BRIAN K WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
25139 ELLA ST, PERRYSBURG, OH 43551-9684
(419) 837-6213
Mailing address
25139 ELLA ST, PERRYSBURG, OH 43551-9684
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3177
OH
Other
Enumeration date
10/25/2006
Last updated
07/12/2009
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