Provider Demographics
NPI:1104999291
Name:BOGHOSIAN, KARLOS (DC)
Entity type:Individual
Prefix:DR
First Name:KARLOS
Middle Name:
Last Name:BOGHOSIAN
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 1:24 LEWIS STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1607
Mailing Address - Country:US
Mailing Address - Phone:860-278-9141
Mailing Address - Fax:
Practice Address - Street 1:24 LEWIS STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1607
Practice Address - Country:US
Practice Address - Phone:860-278-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001584CT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001376Medicare ID - Type Unspecified