Provider Demographics
NPI:1215088836
Name:HOGLUND CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:HOGLUND CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-452-5826
Mailing Address - Street 1:1395 N COURTENAY PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4475
Mailing Address - Country:US
Mailing Address - Phone:321-452-5826
Mailing Address - Fax:321-452-5750
Practice Address - Street 1:1395 N COURTENAY PKWY STE 205
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4475
Practice Address - Country:US
Practice Address - Phone:321-452-5826
Practice Address - Fax:321-452-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO5125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCHOOO5125OtherSTATE LICENSE #
FLCHOOO5125OtherSTATE LICENSE #
FLT94460Medicare UPIN