Individual
DR. JAMEY PAUL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
8103 HIGHWAY 72 W, SUITE B, MADISON, AL 35758-9528
(256) 864-8470
(256) 864-8470
Mailing address
8103 HIGHWAY 72 W, SUITE B, MADISON, AL 35758-9528
(256) 864-8470
(256) 864-8470
Taxonomy
Speciality
Code
Description
License number
State
111NI0900X
Internist Chiropractor
Primary
1765
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51046363
BLUE CROSS BLUE SHIELD
AL
01
—
5192287
AETNA
AL
01
—
641153
ACN
AL
Enumeration date
01/28/2007
Last updated
07/09/2007
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