Provider Demographics
NPI:1427066497
Name:BOGUE, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BOGUE
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 1:104 W ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:209-261-2865
Mailing Address - Fax:209-384-9543
Practice Address - Street 1:104 W ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-261-2865
Practice Address - Fax:209-384-9543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0209190Medicare ID - Type Unspecified
U44257Medicare UPIN