Provider Demographics
NPI:1053441154
Name:LAWRENCE RAY BOGGS JR
Entity Type:Organization
Organization Name:LAWRENCE RAY BOGGS JR
Other - Org Name:BOGGS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:806-935-4003
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-1148
Mailing Address - Country:US
Mailing Address - Phone:806-935-4003
Mailing Address - Fax:806-935-4003
Practice Address - Street 1:613 E 1ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029
Practice Address - Country:US
Practice Address - Phone:806-935-4003
Practice Address - Fax:806-935-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600023OtherBCBS
TX600023Medicare PIN
TX600023OtherBCBS