Organization
DAYTONA MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNATHAN LIVINGSTON WAGNER D.C (OWNER)
(386) 463-4444
Entity
Organization
Contact information
Practice address
125 MASON AVE, DAYTONA BEACH, FL 32117-5017
(386) 463-4444
(386) 313-0304
Mailing address
125 MASON AVE, DAYTONA BEACH, FL 32117-5017
(386) 463-4444
(386) 313-0304
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881628220
NPI TYPE 1
FL
Enumeration date
03/23/2016
Last updated
05/31/2017
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