Provider Demographics
NPI:1518173301
Name:BOGGS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BOGGS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-255-4325
Mailing Address - Street 1:1808 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3331
Mailing Address - Country:US
Mailing Address - Phone:304-255-4325
Mailing Address - Fax:304-255-4395
Practice Address - Street 1:1808 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3331
Practice Address - Country:US
Practice Address - Phone:304-255-4325
Practice Address - Fax:304-255-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVV01309Medicare UPIN
WV9354751Medicare ID - Type UnspecifiedGROUP ID