Provider Demographics
NPI:1053507517
Name:ROBERT D. BOGGS D.C., P.C.
Entity Type:Organization
Organization Name:ROBERT D. BOGGS D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-936-9900
Mailing Address - Street 1:12316 N MAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1944
Mailing Address - Country:US
Mailing Address - Phone:405-936-9900
Mailing Address - Fax:405-936-9055
Practice Address - Street 1:12316 N MAY AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1944
Practice Address - Country:US
Practice Address - Phone:405-936-9900
Practice Address - Fax:405-936-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244312401Medicare PIN