Individual
DR. JEREMY M WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
615 PENNSYLVANIA AVE, SHEBOYGAN, WI 53081-4642
(404) 754-6779
Mailing address
615 PENNSYLVANIA AVE, SHEBOYGAN, WI 53081-4642
(404) 754-6779
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4838-12
WI
111N00000X
Chiropractor
CHIR008777
GA
Other
Enumeration date
02/02/2011
Last updated
07/06/2012
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