Healthcare Provider Details

I. General information

NPI: 1801837851
Provider Name (Legal Business Name): TODD HOWARD BOGOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CONCORD AVENUE STE 101
WILMINGTON DE
19802-3366
US

IV. Provider business mailing address

1010 CONCORD AVENUE STE 101
WILMINGTON DE
19802-3366
US

V. Phone/Fax

Practice location:
  • Phone: 302-777-5551
  • Fax: 302-777-5567
Mailing address:
  • Phone: 302-777-5551
  • Fax: 302-777-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC05538
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007803L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000687
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: