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Organization

WAGNER CHIROPRACTIC CLINIC, PC

Active
Other names
West Omaha Chiropractic & Sports Injury Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TREVOR JOHN WAGNER D.C. (VP)
(402) 334-4700
Entity
Organization

Contact information

Practice address
2639 S 159TH PLZ, OMAHA, NE 68130-1705
(402) 334-4700
(402) 334-0891
Mailing address
2639 S 159TH PLZ, OMAHA, NE 68130-1705
(402) 334-4700
(402) 334-0891

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1124
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36614
BLUE CROSS FOR J OWEN-WAG
NE
01
36615
BLUE CROSS FOR T WAGNER
NE
Enumeration date
10/05/2006
Last updated
08/22/2020
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