Provider Demographics
NPI:1255417978
Name:HOGAN, THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:HOGAN
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 1:12400 W HIGHWAY 71 STE 240
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6511
Mailing Address - Country:US
Mailing Address - Phone:512-402-0440
Mailing Address - Fax:512-402-0141
Practice Address - Street 1:12400 W HIGHWAY 71 STE 240
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6511
Practice Address - Country:US
Practice Address - Phone:512-402-0440
Practice Address - Fax:512-402-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606400Medicare UPIN
TXDC8701Medicare UPIN
TX8B5364Medicare PIN