Provider Demographics
NPI:1851510093
Name:JOSEPH BOGART DC PA
Entity Type:Organization
Organization Name:JOSEPH BOGART DC PA
Other - Org Name:PARKSIDE HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOGART
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCEP
Authorized Official - Phone:954-340-7545
Mailing Address - Street 1:6662 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1694
Mailing Address - Country:US
Mailing Address - Phone:954-340-7545
Mailing Address - Fax:954-340-8925
Practice Address - Street 1:6662 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-1694
Practice Address - Country:US
Practice Address - Phone:954-340-7545
Practice Address - Fax:954-340-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7905111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381523400Medicaid
FL381523400Medicaid
FLK6725Medicare ID - Type UnspecifiedMEDICARE BILLING
FL=========OtherTIN
FLU79380Medicare UPIN