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Individual

DR. TREVOR JOHN WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
2639 S 159TH PLZ, OMAHA, NE 68130-1705
(402) 334-4700
(402) 334-0891
Mailing address
6411 S 172ND AVE, OMAHA, NE 68135-3080
(402) 891-1249
(402) 334-0891

Taxonomy

Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
1125
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36615
BLUE CROSS/BLUE SHIELD
NE
05
47-0802260 05
NE
Enumeration date
06/06/2006
Last updated
07/08/2007
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