Provider Demographics
NPI:1326067091
Name:MOGAN, THOMAS F (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:MOGAN
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 1:22 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1909
Mailing Address - Country:US
Mailing Address - Phone:207-284-5213
Mailing Address - Fax:
Practice Address - Street 1:184 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5558
Practice Address - Country:US
Practice Address - Phone:207-784-8414
Practice Address - Fax:207-784-8363
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MET31285Medicare UPIN
MEMM0090Medicare ID - Type Unspecified