Provider Demographics
NPI:1487788592
Name:HOGG CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:HOGG CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WAURZYNIAK-HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-386-9494
Mailing Address - Street 1:430 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5820
Mailing Address - Country:US
Mailing Address - Phone:563-386-9494
Mailing Address - Fax:563-386-0135
Practice Address - Street 1:430 W 35TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5820
Practice Address - Country:US
Practice Address - Phone:563-386-9494
Practice Address - Fax:563-386-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06848111N00000X
IA04916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17371Medicare PIN