BLAKE JOSEPH WAGNER (NPI# 1134267735) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134267735 |
| Entity Type | Individual |
| Full Name | BLAKE JOSEPH WAGNER |
| Credential | D.C. |
| Practice Address |
21505 Market Pl Nw Suite 102 Poulsbo WA 98370-6635 |
| Mailing Address |
21505 Market Place Nw Suite 102 Poulsbo WA 98370 |
| Practice Telephone | 3605983143 |
| Practice Fax Number | 3605984172 |
| Mailing Telephone | 3605983143 |
| Mailing Fax Number | 3605984172 |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2011-04-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | CH00003095 | WA | Chiropractic Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013069061 | Blake Douglas Wagner Jr. | Psychologist | 1575 Marion Ave, Mansfield, OH 44906-3409 | 2007-01-18 |
| 1811057664 | Blake Douglas Wagner | Physical Therapist | 3111 Gordon Drive, Sioux City, IA 51106 | 2006-12-11 |
| Street Address |
21505 MARKET PL NW SUITE 102 |
| City | POULSBO |
| State | WA |
| Zip Code | 98370-6635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629377940 | Wagner Family Wellness Center LLC | Chiropractor | 21505 Market Pl Nw, Suite 102, Poulsbo, WA 98370-6635 | 2011-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790324010 | Francie Corinn Edens | Massage Therapist | 225 Nw Lindvig Way Suite# 6, Poulsbo, WA 98370 | 2020-01-03 |
| 1972155679 | Marcela Serocki | Massage Therapist | 18657 Wa-305, Suite 4, Poulsbo, WA 98370 | 2019-07-12 |
| 1508425943 | Ryan Brinton | Physical Therapist | Kitsap Physical Therapy and Sports Clinics, 19319 7th Ave Ne Ste 108, Poulsbo, WA 98370 | 2019-06-10 |
| 1598220816 | Naomi Whitney Orong | Massage Therapist | 19068 Nw Jenson Way, Suite 4b, Poulsbo, WA 98370 | 2019-02-01 |
| 1043774953 | Maryanne Phillips Bellman | Physical Therapist | 442 Viewmont Ave, Poulsbo, WA 98370 | 2019-01-24 |
| 1285102293 | Andrea Sander | Registered Nurse | 19883 12th Ave Ne, Poulsbo, WA 98370 | 2018-11-07 |
| 1376038281 | Sharon Renay Christor | Nurse Practitioner | 19160 Front St. Ne, Poulsbo, WA 98370 | 2018-06-25 |
| 1700304334 | Samantha Przybylek Gavinski | Nurse Practitioner | 19500 10th Ave Ne Suite 100, Poulsbo, WA 98370 | 2017-09-04 |
| 1285164327 | Johanna Taylor | Behavior Technician | 21786 Windmill Loop Nw, Poulsbo, WA 98370 | 2017-06-12 |
| 1568990554 | Eva Geurtsen | Physical Therapy Assistant | 19160 Front St, Poulsbo, WA 98370 | 2017-06-02 |
| Find all providers in zip 98370 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326421629 | The Atmosphere | Chiropractor | 2095 Nw Luoto Rd, Poulsbo, WA 98370 | 2015-07-06 |
| 1619281672 | Brandy Jean Morgan | Chiropractor | 20714 State Highway 305 Ne, Suite 1f, Poulsbo, WA 98370-8787 | 2010-08-02 |
| 1528261245 | Gip Inc | Chiropractor | 19337 Jensen Way Ne, Poulsbo, WA 98370 | 2007-06-08 |
| 1770786014 | Michelle Cho Gip | Chiropractor | 19045 State Highway 305 Ne, Ste 190, Poulsbo, WA 98370-7312 | 2007-06-06 |
| 1396954350 | Patricia Lynn Pettapiece | Chiropractor | 21222 Viking Way Nw, Poulsbo, WA 98370-9491 | 2007-05-22 |
| 1558484592 | North Peninsula Chiropractic | Chiropractor | 20696 Bond Rd Ne Ste 210, Poulsbo, WA 98370-9025 | 2007-04-06 |
| 1699829663 | Angel Wunder | Chiropractor | 18978 8th Ave Ne, Poulsbo, WA 98370-7349 | 2007-01-23 |
| 1497802680 | Dr Craig A. Benson Chiropractic Clinic Inc | Chiropractor | 17791 Fjord Dr Ne Ste 214, Poulsbo, WA 98370-8481 | 2007-01-03 |
| 1881752343 | Life Force Chiropractic of Poulsbo Inc | Chiropractor | 1016 Ne Forest Rock Ln, Suite 105, Poulsbo, WA 98370-9040 | 2006-12-05 |
| 1316014558 | Kelly E Breen | Chiropractor | 19421 7th Ave Ne, Poulsbo, WA 98370 | 2006-11-30 |
| Find all providers in POULSBO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.