Individual
TIMOTHY ALLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2016 W. HOUSTON, BROKEN ARROW, OK 74012
(918) 742-2094
(918) 742-2095
Mailing address
2016 W. HOUSTON, BROKEN ARROW, OK 74012
(918) 742-2094
(918) 742-2095
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3225
OK
Other
Enumeration date
05/10/2006
Last updated
07/10/2014
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