Provider Demographics
NPI:1740384841
Name:BOGGS, TODD WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WILLIAM
Last Name:BOGGS
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 1:1605 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2409
Mailing Address - Country:US
Mailing Address - Phone:308-436-2801
Mailing Address - Fax:308-436-2872
Practice Address - Street 1:1605 10TH ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2409
Practice Address - Country:US
Practice Address - Phone:308-436-2801
Practice Address - Fax:308-436-2872
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE99562OtherBC/BS
NE47084054700Medicaid
NE99562OtherBC/BS
NE274281Medicare ID - Type Unspecified