Provider Demographics
NPI:1174794515
Name:BOGGS P.C
Entity type:Organization
Organization Name:BOGGS P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SERGEI
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-788-3935
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-0467
Mailing Address - Country:US
Mailing Address - Phone:248-788-3935
Mailing Address - Fax:248-788-3946
Practice Address - Street 1:7330 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1065
Practice Address - Country:US
Practice Address - Phone:248-788-3935
Practice Address - Fax:248-788-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M77770Medicare PIN