Provider Demographics
NPI:1164422093
Name:BOGART, JOSEPH M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:BOGART
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 1:6662 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1694
Mailing Address - Country:US
Mailing Address - Phone:954-340-7545
Mailing Address - Fax:954-340-8925
Practice Address - Street 1:6662 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-1694
Practice Address - Country:US
Practice Address - Phone:954-340-7545
Practice Address - Fax:954-340-8925
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280016100Medicaid
FL55949AMedicare ID - Type Unspecified
U79380Medicare UPIN