1801951983 NPI number — DR. MATTHIAS HEINRICH WAGNER D.C.

Table of content: DR. MATTHIAS HEINRICH WAGNER D.C. (NPI 1801951983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801951983 NPI number — DR. MATTHIAS HEINRICH WAGNER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGNER
Provider First Name:
MATTHIAS
Provider Middle Name:
HEINRICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801951983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9227 N OAK TRFY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64155-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-420-3072
Provider Business Mailing Address Fax Number:
816-420-3077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9227 N OAK TRFY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64155-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-420-3072
Provider Business Practice Location Address Fax Number:
816-420-3077
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2003015538 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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