Provider Demographics
NPI:1811077662
Name:BOGAR, WILLIAM CHARLES (DC DACBR)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:BOGAR
Suffix:
Gender:M
Credentials:DC DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134
Mailing Address - Country:US
Mailing Address - Phone:630-208-0346
Mailing Address - Fax:630-208-0346
Practice Address - Street 1:1618 SUNSET ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-208-0346
Practice Address - Fax:630-208-0346
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005260111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04525569OtherBCBS ILLINOIS
336250Medicare ID - Type Unspecified
U46772Medicare UPIN