Provider Demographics
NPI:1104415660
Name:BOGGS, CHANDLER (DC)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:BOGGS
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 1:1103 FALCON CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9044
Mailing Address - Country:US
Mailing Address - Phone:260-797-8123
Mailing Address - Fax:260-489-1819
Practice Address - Street 1:1114 W COOK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3214
Practice Address - Country:US
Practice Address - Phone:260-483-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003209A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor