Provider Demographics
NPI:1699334912
Name:BOGGESS, JENNIFER L (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BOGGESS
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 1:6220 ANTIOCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66202-5107
Mailing Address - Country:US
Mailing Address - Phone:913-725-8735
Mailing Address - Fax:
Practice Address - Street 1:6220 ANTIOCH RD STE 100
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66202-5107
Practice Address - Country:US
Practice Address - Phone:913-725-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor