Provider Demographics
NPI:1588699680
Name:BOGGS, CASEY R (DC)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:R
Last Name:BOGGS
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 1:4212 TOWN CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685
Mailing Address - Country:US
Mailing Address - Phone:330-896-2424
Mailing Address - Fax:330-896-3294
Practice Address - Street 1:4212 TOWN CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685
Practice Address - Country:US
Practice Address - Phone:330-896-2424
Practice Address - Fax:330-896-3294
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513499Medicaid
OHV01869Medicare UPIN
OH4144791Medicare ID - Type Unspecified