Individual
DR. JEFFREY LYNN WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
309 REGENCY PKWY STE 205, MANSFIELD, TX 76063-7305
(817) 453-0430
(817) 453-0400
Mailing address
309 REGENCY PKWY STE 205, MANSFIELD, TX 76063-7305
(817) 453-0430
(817) 453-0400
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9382
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8R1160
BLUE CROSS BLUE SHIELD #
TX
Enumeration date
01/09/2007
Last updated
01/02/2013
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