Provider Demographics
NPI:1841785573
Name:BHAGAN, ROBERT JOHN (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:BHAGAN
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 1:14547 LONDON LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2579
Mailing Address - Country:US
Mailing Address - Phone:301-529-3376
Mailing Address - Fax:
Practice Address - Street 1:14547 LONDON LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2579
Practice Address - Country:US
Practice Address - Phone:301-529-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty