Provider Demographics
NPI:1124158167
Name:VANWAGNER, JARED A (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:A
Last Name:VANWAGNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7550 MISSION HILLS DR
Mailing Address - Street 2:SUITE 316
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9603
Mailing Address - Country:US
Mailing Address - Phone:239-775-6416
Mailing Address - Fax:239-775-6407
Practice Address - Street 1:7550 MISSION HILLS DR
Practice Address - Street 2:SUITE 316
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9603
Practice Address - Country:US
Practice Address - Phone:239-775-6416
Practice Address - Fax:239-775-6407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009240111N00000X
FLCH10841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor