Provider Demographics
NPI:1912147224
Name:BOGAC, ROBERT ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:BOGAC
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 1:422 SEWICKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HERMINIE
Mailing Address - State:PA
Mailing Address - Zip Code:15637-1441
Mailing Address - Country:US
Mailing Address - Phone:724-446-1318
Mailing Address - Fax:724-446-1318
Practice Address - Street 1:422 SEWICKLEY AVE
Practice Address - Street 2:
Practice Address - City:HERMINIE
Practice Address - State:PA
Practice Address - Zip Code:15637-1441
Practice Address - Country:US
Practice Address - Phone:724-446-1318
Practice Address - Fax:724-446-1318
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007528-L111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor