Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 830 | ND |
NPI | 1982855888 |
---|---|
Provider Name | Dr. Ashley Lynn Wagner |
First Address | Bismarck, ND 58503-0877 |
Second Address | Bismarck, ND 58503-0877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2008 |
Last Update Date | 16/12/2008 |