Provider Demographics
NPI:1548457922
Name:BOGREN CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:BOGREN CHIROPRACTIC HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-743-1261
Mailing Address - Street 1:332 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541
Mailing Address - Country:US
Mailing Address - Phone:304-743-1261
Mailing Address - Fax:304-743-1899
Practice Address - Street 1:332 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541
Practice Address - Country:US
Practice Address - Phone:304-743-1261
Practice Address - Fax:304-743-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001711177OtherBLUE CROSS BLUE SHIELD
WV0131934000Medicaid
WV0131934000Medicaid
B00756181Medicare PIN