Healthcare Provider Details

I. General information

NPI: 1740384841
Provider Name (Legal Business Name): TODD WILLIAM BOGGS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 10TH ST
GERING NE
69341-2409
US

IV. Provider business mailing address

1605 10TH ST
GERING NE
69341-2409
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-2801
  • Fax: 308-436-2872
Mailing address:
  • Phone: 308-436-2801
  • Fax: 308-436-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1179
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: