Christian Wagner, | |
1233 Main Ave, Clifton, NJ 07011-2241 | |
(973) 604-0260 | |
Not Available |
Full Name | Christian Wagner |
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Gender | Male |
Speciality | Chiropractor |
Location | 1233 Main Ave, Clifton, New Jersey |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1114798642 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 38MC00801700 (New Jersey) | Primary |
Provider Name | Sportsmed Pt Llc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1841787645 PECOS PAC ID: 0749535805 Enrollment ID: O20180614001056 |
Mailing Address | Practice Location Address |
---|---|
Christian Wagner, 21 Stone Ct, Morristown, NJ 07960-3177 Ph: (518) 937-6894 | Christian Wagner, 1233 Main Ave, Clifton, NJ 07011-2241 Ph: (973) 604-0260 |
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