Wagner, Trevor John
Wagner, Trevor John is an individual health care provider with primary practice located at 2639 S 159Th Plz , Omaha NE 68130-1705. He recently has only one registered license in Chiropractic Providers / Sports Physician, which is considered as his primary health care specialty. Wagner, Trevor John can be contacted via phone (402) 334-4700.Contact Information
Primary practice address
2639 S 159Th Plz
Omaha NE 68130-1705
Phone: (402) 334-4700
Fax: (402) 334-0891
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Sports Physician | 111NS0005X | 1125 | Nebraska |
Profile Details
| NPI number | 1740229566 |
|---|---|
| LBN Legal business name | Wagner, Trevor John |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years 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 | 1740229566 | NPPES |
| Nebraska | Other | 36615 | BLUE CROSS/BLUE SHIELD |
| Nebraska | MEDICAID | 47-0802260 05 | BLUE CROSS/BLUE SHIELD |
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