Provider Demographics
NPI:1942360474
Name:BOGGS, DANIEL (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
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 1:2565 S ROCHESTER RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4472
Mailing Address - Country:US
Mailing Address - Phone:586-299-8900
Mailing Address - Fax:586-299-8923
Practice Address - Street 1:2565 S ROCHESTER RD
Practice Address - Street 2:STE 105
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4472
Practice Address - Country:US
Practice Address - Phone:586-299-8900
Practice Address - Fax:586-299-8923
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4074512Medicaid
950F334360OtherBLUECROSS
383453464Medicare UPIN
OM7770Medicare ID - Type Unspecified