Individual
DR. JOHNATHAN LIVINGSTON WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS,DC
Contact information
Practice address
542 N RIDGEWOOD AVE, DAYTONA BEACH, FL 32114-2170
(386) 258-7494
(386) 253-0365
Mailing address
542 N. RIDGEWOOD AVE., DAYTONA BEACH, FL 32114
(386) 258-7494
(386) 253-0365
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
CH8731
FL
Other
Enumeration date
07/10/2006
Last updated
02/15/2008
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