Provider Demographics
NPI:1770695173
Name:KOGUT, FORREST FRANK (DC)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:FRANK
Last Name:KOGUT
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 1:601 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041
Mailing Address - Country:US
Mailing Address - Phone:847-587-8011
Mailing Address - Fax:847-587-5469
Practice Address - Street 1:601 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041
Practice Address - Country:US
Practice Address - Phone:847-587-8011
Practice Address - Fax:847-587-5469
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3501111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T37366Medicare UPIN
IL635380Medicare ID - Type Unspecified