Provider Demographics
NPI:1366527376
Name:WAGNER, JAMES COLIN (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:COLIN
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7403 CHURCH RANCH BLVD.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8609
Mailing Address - Country:US
Mailing Address - Phone:303-420-4560
Mailing Address - Fax:303-438-1615
Practice Address - Street 1:7403 CHURCH RANCH BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6074
Practice Address - Country:US
Practice Address - Phone:303-420-4560
Practice Address - Fax:303-438-1615
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBC 2768-3Medicare UPIN