Provider Demographics
NPI:1962475335
Name:HOGAN, WAYNE A (DC)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:HOGAN
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:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-0591
Mailing Address - Country:US
Mailing Address - Phone:518-664-5281
Mailing Address - Fax:518-664-2106
Practice Address - Street 1:905 HUDSON RIVER RD
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-0591
Practice Address - Country:US
Practice Address - Phone:518-664-5281
Practice Address - Fax:518-664-2106
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX03080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10029193OtherCDPHP
NY10029193OtherCDPHP