| NPI | 1598774655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT BRIAN WAGNER Owner 434-978-4888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104555923) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2010-09-08 |