Provider Demographics
NPI:1003089756
Name:KENNETH J HOGAN CHTD
Entity Type:Organization
Organization Name:KENNETH J HOGAN CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-650-2227
Mailing Address - Street 1:2675 E FLAMINGO RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5211
Mailing Address - Country:US
Mailing Address - Phone:702-650-2227
Mailing Address - Fax:702-650-9654
Practice Address - Street 1:2675 E FLAMINGO RD
Practice Address - Street 2:SUITE 9
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5211
Practice Address - Country:US
Practice Address - Phone:702-650-2227
Practice Address - Fax:702-650-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVDC533Medicare PIN