DR. GERRIT LEE WAGNER D.C., L.AC
NPI 1720480189
Chiropractor in Redlands, CA

Q: What is Gerrit Wagner's NPI number?

The NPI number for Gerrit Wagner is 1720480189. It was assigned to this individual provider in the NPPES registry on September 17, 2014.

Q: What is Gerrit Wagner's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Q: When was this NPI record last updated?

The NPPES record for Gerrit Wagner was last updated on March 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 17, 2014Accepts Medicare Assignment

620 ALABAMA ST, REDLANDS, CA 92373(909) 792-4434(909) 335-1139 Get Directions Write a Review

NPPES record last updated: March 3, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dr. Gerrit Lee Wagner D.c., L.ac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GERRIT LEE WAGNER D.C., L.AC (NPI 1720480189) is an individual chiropractor in Redlands, California, licensed in California (DC33062) and active in the NPI registry since September 2014. He is a graduate of Los Angeles College Of Chiropractic (2014).

NPPES Registry Identity

NPI1720480189

Entity TypeIndividualMale

Primary Taxonomy111N00000X

Provider Legal NameDR. GERRIT LEE WAGNERCredential: D.C., L.AC

Location Address620 ALABAMA STRedlands, CA 92373-8059

Mailing Address620 Alabama StRedlands, CA 92373-8059 · (909) 792-4434 · Fax (909) 335-1139

Phone(909) 792-4434

Fax(909) 335-1139

Sole ProprietorYes

Medical School CMSLos Angeles College Of ChiropracticGraduated 2014

Enumeration DateSeptember 17, 2014

Last NPPES UpdateMarch 3, 2015

✔ NPI 1720480189 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

License✔ Licensed in CA · DC33062

Definition

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.

Also ListedAcupuncturistTaxonomy 171100000X · License AC16183 (CA)

620 ALABAMA ST, Redlands, CA 92373

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Gerrit Lee Wagner D.c., L.ac is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709007263

PECOS Enrollment IDI20141027000340

Medicare Billing Reassignment

Medicare enrollment records show Gerrit Wagner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Phillips-White Chiropractic Corporation

Same address

Chiropractor

620 ALABAMA ST
Redlands, CA 92373

Reassigned Medicare billing, California enrollment
12 clinicians in this Medicare group

NPI 1336265362 (909) 792-4434

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Chiropractic manipulative treatment, 3-4 spinal regions 98941

Chiropractic manipulative treatment for 3-4 spinal regions involves a trained professional applying controlled force to specific areas of your spine. This can help alleviate pain, improve physical function, and support your body's natural healing process.

154 services27 patients

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SANG EUN LEE D.D.S. INC.

Dentist (General Practice)