Provider Demographics
NPI:1033128558
Name:WOGAHN, MARK J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:WOGAHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:18762 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3303
Mailing Address - Country:US
Mailing Address - Phone:818-342-2299
Mailing Address - Fax:818-342-7010
Practice Address - Street 1:18762 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3303
Practice Address - Country:US
Practice Address - Phone:818-342-2299
Practice Address - Fax:818-342-7010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC13906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13906Medicare UPIN