Organization
WAGNER CHIROPRACTIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY D WAGNER DC (OWNER/PRESIDENT)
(701) 223-5001
Entity
Organization
Contact information
Practice address
1431 INTERSTATE LOOP, BISMARCK, ND 58503-0510
(701) 223-5001
(701) 223-4709
Mailing address
1431 INTERSTATE LOOP, BISMARCK, ND 58503-0510
(701) 223-5001
(701) 223-4709
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
061
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17241
—
ND
01
—
19785
BCBS OF NORTH DAKOTA
ND
01
—
4404746
MEDICA
ND
01
—
667437
UNITEDHEALTHCARE
ND
01
—
U32827
UPIN
ND
Enumeration date
02/08/2010
Last updated
12/31/2010
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