Provider Demographics
NPI:1609865104
Name:HOGAN, JEFFREY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:HOGAN
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 1:16525 LEXINGTON BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2577
Mailing Address - Country:US
Mailing Address - Phone:281-240-2225
Mailing Address - Fax:281-240-1375
Practice Address - Street 1:16525 LEXINGTON BLVD
Practice Address - Street 2:STE 220
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2577
Practice Address - Country:US
Practice Address - Phone:281-240-2225
Practice Address - Fax:281-240-1375
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83445Medicare UPIN
TX609465Medicare PIN