MEDICARE: DR. WAYNE A HOGAN D.C.

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	X03080	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10029193	OTHER	NY	CDPHP

General Provider Information

NPI Number	:	1962475335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE A HOGAN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 591
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-0591
Country	:	US
Telephone Number	:	518-664-5281
Fax Number	:	518-664-2106

Provider Business Practice Location Address
First Line	:	905 HUDSON RIVER RD
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-0591
Country	:	US
Telephone Number	:	518-664-5281
Fax Number	:	518-664-2106

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	11/16/2010

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