Provider Demographics
NPI:1194797977
Name:BOGDAN, WALTER V JR (DC)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:V
Last Name:BOGDAN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2008 BREMO RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2443
Mailing Address - Country:US
Mailing Address - Phone:804-288-1152
Mailing Address - Fax:804-288-5211
Practice Address - Street 1:2008 BREMO RD
Practice Address - Street 2:SUITE 111
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2443
Practice Address - Country:US
Practice Address - Phone:804-288-1152
Practice Address - Fax:804-288-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104001914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU81073Medicare UPIN
VA3500011232Medicare ID - Type Unspecified