Provider Demographics
NPI:1679769608
Name:HOGANSON CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:HOGANSON CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-537-0307
Mailing Address - Street 1:1307 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3500
Mailing Address - Country:US
Mailing Address - Phone:507-537-0307
Mailing Address - Fax:
Practice Address - Street 1:1307 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3500
Practice Address - Country:US
Practice Address - Phone:507-537-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN81992HOOtherBLUE CROSS BLUE SHIELD
MNC04699Medicare PIN