Provider Demographics
NPI:1053735399
Name:WAGER, JORDAN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:WAGER
Suffix:
Gender:M
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-0306
Mailing Address - Country:US
Mailing Address - Phone:320-312-5000
Mailing Address - Fax:
Practice Address - Street 1:814 6TH STREET
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-5623
Practice Address - Country:US
Practice Address - Phone:320-312-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor