| Doctor Name: | MR. WAYNE P WAGNER |
| NPI Number: | 1568580801 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DC |
| License Number: | X009027 |
| Business Practice Address: | 605 N Spence Ave Goldsboro, NC - 275344263 |
| Business Phone Number: | 5169985431 |
| Business Fax Number: | 5162233757 |
| Mailing Address: | 1119 Jefferson Pl, BALDWIN |
| State: | NY |
| Postal Code: | 115104713 |
| Phone Number: | 5169985431 |
| Fax Number: | 5162233757 |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | X009027 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |