Doctor Name: | DR. KAYLA ELLEN WAGONER |
NPI Number: | 1801229893 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | DC010874 |
Business Practice Address: | 454 Rolling Ridge Dr Suite 4 State College, PA - 168017696 |
Business Phone Number: | 8149544182 |
Business Fax Number: | |
Mailing Address: | 454 Rolling Ridge Dr, Suite 4 STATE COLLEGE |
State: | PA |
Postal Code: | 168017696 |
Phone Number: | 8149544182 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2013 |
NPI Last Update Date: | 12/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | DC010874 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
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. |