Provider Demographics
NPI:1497781280
Name:HOGAN, SHAWNA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:
Last Name:HOGAN
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 1:5953 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-2320
Mailing Address - Country:US
Mailing Address - Phone:850-748-6102
Mailing Address - Fax:
Practice Address - Street 1:4481 LEGENDARY DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5381
Practice Address - Country:US
Practice Address - Phone:850-424-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64135OtherBLUE CROSS/ BLUE SHIELD
FL695781OtherUNITED HEALTHCARE
FL382003300Medicaid
FL7508735OtherAETNA