Provider Demographics
NPI:1972615557
Name:VANWAGNER, SCOTT A (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:VANWAGNER
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 1:10857 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3312
Mailing Address - Country:US
Mailing Address - Phone:804-270-3000
Mailing Address - Fax:804-270-3004
Practice Address - Street 1:10857 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3312
Practice Address - Country:US
Practice Address - Phone:804-270-3000
Practice Address - Fax:804-270-3004
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor