Individual
DR. JODY MICHELLE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
N110 BRUX RD, APPLETON, WI 54915-9439
(920) 968-0464
(920) 968-0482
Mailing address
N110 BRUX RD, APPLETON, WI 54915-9439
(920) 968-0464
(920) 968-0482
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4062-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38957300
—
WI
Enumeration date
06/01/2005
Last updated
06/11/2024
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