Healthcare Provider Details

I. General information

NPI: 1871778258
Provider Name (Legal Business Name): BOGAART FAMILY CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 STATE ROAD Z
PEVELY MO
63070-2102
US

IV. Provider business mailing address

1645 STATE ROAD Z
PEVELY MO
63070-2102
US

V. Phone/Fax

Practice location:
  • Phone: 636-479-6888
  • Fax: 636-479-6088
Mailing address:
  • Phone: 636-479-6888
  • Fax: 636-479-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004020948
License Number StateMO

VIII. Authorized Official

Name: DR. ADAM ALEXANDER BOGAART
Title or Position: OWNER
Credential: DC
Phone: 636-479-6888