Organization
WAGONER HOLDINGS PA
Active
Other names
Wake Forest Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVAN JONATHON WAGONER DC (OWNER)
(260) 573-1249
Entity
Organization
Contact information
Practice address
851 WAKE FOREST BUSINESS PARK STE E, WAKE FOREST, NC 27587-7366
(260) 573-1249
Mailing address
1408 WOODLAND HILLS TRL APT 204, WAKE FOREST, NC 27587-1778
(260) 573-1249
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5176
NC STATE CHIROPRACTIC LICENSE NUMBER
NC
Enumeration date
10/19/2021
Last updated
10/19/2021
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