Provider Demographics
NPI:1003972852
Name:FOGLIA, CHRISTOPHER T (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
Last Name:FOGLIA
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 708
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0769
Mailing Address - Country:US
Mailing Address - Phone:631-750-9290
Mailing Address - Fax:631-750-9291
Practice Address - Street 1:4875 SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4611
Practice Address - Country:US
Practice Address - Phone:631-750-9290
Practice Address - Fax:631-750-9291
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007116111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU3166Medicare UPIN
NYX61921Medicare ID - Type Unspecified