Provider Demographics
NPI:1174515233
Name:HOGAN, STEVE A
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:A
Last Name:HOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 COGGIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-4728
Mailing Address - Country:US
Mailing Address - Phone:325-646-6944
Mailing Address - Fax:325-641-0120
Practice Address - Street 1:1901 COGGIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-4728
Practice Address - Country:US
Practice Address - Phone:325-646-6944
Practice Address - Fax:325-641-0120
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001514101Medicaid
TXT191995Medicare UPIN
TX001514101Medicaid