Organization
WAGNER FAMILY WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE JOSEPH WAGNER D.C. (MEMBER/MANAGER)
(360) 598-3143
Entity
Organization
Contact information
Practice address
21505 MARKET PL NW, SUITE 102, POULSBO, WA 98370-6635
(360) 598-3143
(360) 598-4172
Mailing address
21505 MARKET PL NW, SUITE 102, POULSBO, WA 98370-6635
(360) 598-3143
(360) 598-4172
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00003095
WA
Other
Enumeration date
03/25/2011
Last updated
12/29/2011
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