Provider Demographics
NPI:1447611421
Name:BOGHOZIAN, GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BOGHOZIAN
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 1:9730 BRIMHALL RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2786
Mailing Address - Country:US
Mailing Address - Phone:661-410-9355
Mailing Address - Fax:661-410-0009
Practice Address - Street 1:9730 BRIMHALL RD STE 3
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2786
Practice Address - Country:US
Practice Address - Phone:661-410-9355
Practice Address - Fax:661-410-0009
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1008872Medicaid