Provider Demographics
NPI:1063431955
Name:HOGLUND, EDWARD WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:HOGLUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 N. COURTENAY PKWY.
Mailing Address - Street 2:#205
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953
Mailing Address - Country:US
Mailing Address - Phone:321-452-5826
Mailing Address - Fax:321-452-5750
Practice Address - Street 1:1395 N. COURTENAY PKWY.
Practice Address - Street 2:#205
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953
Practice Address - Country:US
Practice Address - Phone:321-452-5826
Practice Address - Fax:321-452-5750
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO5125111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCHOOO5125OtherLICENSE NUMBER
FLCHOOO5125OtherLICENSE NUMBER
FL70862Medicare ID - Type Unspecified