Organization
WAGONER HOLDINGS PA
Active
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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