Wagner, Jody Michelle
Wagner, Jody Michelle is an sole proprietor health care provider with primary practice located at N110 Brux Rd , Appleton WI 54915-9439. She recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as her primary health care specialty. Wagner, Jody Michelle can be contacted via phone (920) 968-0464.Contact Information
Primary practice address
N110 Brux Rd
Appleton WI 54915-9439
Phone: (920) 968-0464
Fax: (920) 968-0482
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 4062-012 | Wisconsin |
Profile Details
| NPI number | 1487656799 |
|---|---|
| LBN Legal business name | Wagner, Jody Michelle |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 1st, 2005 |
| Last updated | Jun 11th, 2024 - about 6 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487656799 | NPPES |
| Wisconsin | MEDICAID | 38957300 |
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