Provider Demographics
NPI:1285981365
Name:BOGAN, ALLISON MARIE (DC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:BOGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CORNERSTONE DR. STE 215
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-557-0527
Mailing Address - Fax:802-488-3037
Practice Address - Street 1:300 CORNERSTONE DR. STE 215
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-557-0527
Practice Address - Fax:802-488-3037
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060088965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor