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General NPI Number Information
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NPI Number | 1174794515
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Entity Type | Organization
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Legal Business Name | BOGGS P.C
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 7330 HAGGERTY RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1065
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Country | US
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Telephone | 248-788-3935
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Fax | 248-788-3946
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | WALLED LAKE
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State | MI
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Zip | 48390-0467
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Country | US
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Telephone | 248-788-3935
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Fax | 248-788-3946
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. DANIEL SERGEI BOGGS
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Credential | DC
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Telephone | 248-788-3935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301007672
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License Number State | MI
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