Organization
MANUAL MEDICINE AND REHABILITATION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN WAGNER DC (PRESIDENT)
(503) 774-3778
Entity
Organization
Contact information
Practice address
5802 SE POWELL BLVD, PORTLAND, OR 97206-2826
(503) 774-3778
(503) 774-3880
Mailing address
5802 SE POWELL BLVD, #100, PORTLAND, OR 97206-2826
(503) 774-3778
(503) 774-3880
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5814
OR
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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