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1689814634 NPI number — DEREK B KOGAN D.C., L.AC

NPI Number: 1689814634
Health Care Provider/Practitioner: DEREK B KOGAN D.C., L.AC

Information about “1689814634” NPI (DEREK B KOGAN D.C., L.AC) exists in 1689814634 in HTML format HTML  |  1689814634 in plain Text format TXT  |  1689814634 in PDF (Portable Document Format) PDF  |  1689814634 in an XML format XML  formats.

NPI Number : 1689814634 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689814634",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOGAN",
    "FirstName": "DEREK",
    "MiddleName": "B",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.C., L.AC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KOGAN",
    "OtherFirstName": "DEREK",
    "OtherMiddleName": "B",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DC, LAC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "6055 LEHMAN DR STE 105",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLORADO SPRINGS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80918-5486",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-246-9276",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6055 LEHMAN DR STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLORADO SPRINGS",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80918-5486",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-246-9276",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/04/2009",
    "LastUpdateDate": "04/16/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "2151",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "7357",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "13090",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "33225",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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