Individual
JAY FREDERICK WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
454 ROLLING RIDGE DR, SUITE 4, STATE COLLEGE, PA 16801-7696
(814) 954-4182
Mailing address
454 ROLLING RIDGE DR, SUITE 4, STATE COLLEGE, PA 16801-7696
(814) 954-4182
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC010942
PA
Other
Enumeration date
12/11/2014
Last updated
02/28/2017
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