Provider Demographics
NPI:1003992835
Name:BOGAART, ERIC KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KENNETH
Last Name:BOGAART
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 1:907 TULLAR RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3617
Mailing Address - Country:US
Mailing Address - Phone:920-722-9200
Mailing Address - Fax:920-722-9202
Practice Address - Street 1:907 TULLAR RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3617
Practice Address - Country:US
Practice Address - Phone:920-722-9200
Practice Address - Fax:920-722-9202
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4143-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38964100Medicaid
WI38964100Medicaid
WIV07842Medicare UPIN