Provider Demographics
NPI:1396816559
Name:FOGLER, WILLIAM JR (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:FOGLER
Suffix:JR
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 1:25 ROUTE 31 S
Mailing Address - Street 2:STE I
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2500
Mailing Address - Country:US
Mailing Address - Phone:609-737-2006
Mailing Address - Fax:609-737-2009
Practice Address - Street 1:25 ROUTE 31 S
Practice Address - Street 2:STE I
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2500
Practice Address - Country:US
Practice Address - Phone:609-737-2006
Practice Address - Fax:609-737-2009
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00552000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031831NMCMedicare ID - Type Unspecified