MEDICARE: BOGART FAMILY CHIROPRACTIC

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	2301010168	MI

General Provider Information

NPI Number	:	1871042143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOGART FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	PO BOX 224
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-0224
Country	:	US
Telephone Number	:	989-576-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 W MAIN ST
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-5104
Country	:	US
Telephone Number	:	231-256-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CASEY A VANDYKE
Credential	:
Telephone Number	:	989-576-0386

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/16/2024

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Directions to “BOGART FAMILY CHIROPRACTIC ” Practice Location

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