Provider Demographics
NPI:1225334238
Name:HOGLEN, ANDREA RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RUTH
Last Name:HOGLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 FOREST AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1780
Mailing Address - Country:US
Mailing Address - Phone:734-751-8068
Mailing Address - Fax:
Practice Address - Street 1:580 FOREST AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:734-751-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor