Provider Demographics
NPI:1871545376
Name:WAGNER, CATHERINE M (DC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1241
Mailing Address - Country:US
Mailing Address - Phone:845-778-2184
Mailing Address - Fax:845-778-3841
Practice Address - Street 1:70 OAK ST
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1241
Practice Address - Country:US
Practice Address - Phone:845-778-2184
Practice Address - Fax:845-778-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU70705Medicare UPIN
NYX8A251Medicare PIN