Individual
DEADRA L WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
1459 MIAMI RD, BENTON HARBOR, MI 49022-6055
(269) 208-7031
Mailing address
1459 MIAMI RD, BENTON HARBOR, MI 49022-6055
(269) 208-7031
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038009468
IL
Other
Enumeration date
03/07/2007
Last updated
01/20/2010
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