Provider Demographics
NPI:1720199367
Name:COGAN, SOLOMON L (DC)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:L
Last Name:COGAN
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 1:3890 LAKELAND LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1327
Mailing Address - Country:US
Mailing Address - Phone:248-366-1055
Mailing Address - Fax:
Practice Address - Street 1:24100 DRAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3155
Practice Address - Country:US
Practice Address - Phone:248-471-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F353260OtherBCBS ID
MI0F35326Medicare ID - Type Unspecified