Provider Demographics
NPI:1225209620
Name:WAGNER CHIROPRACTIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:WAGNER CHIROPRACTIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-531-8701
Mailing Address - Street 1:421 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1255
Mailing Address - Country:US
Mailing Address - Phone:412-531-8701
Mailing Address - Fax:412-531-8703
Practice Address - Street 1:421 COCHRAN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1255
Practice Address - Country:US
Practice Address - Phone:412-531-8701
Practice Address - Fax:412-531-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1909153OtherBC/BS