MEDICARE: DR. RONALD MICHAEL BOGGS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301005293	MI

General Provider Information

NPI Number	:	1265416614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD MICHAEL BOGGS DC

Provider Business Mailing Address
First Line	:	26245 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4546
Country	:	US
Telephone Number	:	248-569-0366
Fax Number	:	248-569-5843

Provider Business Practice Location Address
First Line	:	26245 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4546
Country	:	US
Telephone Number	:	248-569-0366
Fax Number	:	248-569-5843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/02/2007

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