Provider Demographics
NPI:1457575029
Name:HOGENSON, WAYNE ALLEN (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALLEN
Last Name:HOGENSON
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 1:3701 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582
Mailing Address - Country:US
Mailing Address - Phone:574-269-2469
Mailing Address - Fax:574-269-3369
Practice Address - Street 1:3701 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582
Practice Address - Country:US
Practice Address - Phone:574-269-2469
Practice Address - Fax:574-269-3369
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000186840OtherANTHEM BCBS
IN147840Medicare ID - Type Unspecified