MEDICARE: DR. RICHARD J. BOGDANSKI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X2892	NY

General Provider Information

NPI Number	:	1003928169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J. BOGDANSKI DC

Provider Business Mailing Address
First Line	:	160 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	631-727-7200
Fax Number	:	631-727-7252

Provider Business Practice Location Address
First Line	:	160 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	631-727-7200
Fax Number	:	631-727-7252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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