Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2912 | TN |
NPI | 1003274812 |
---|---|
Provider Name | Charles Hogan |
First Address | Cordova, TN 38016-3307 |
Second Address | Cordova, TN 38016-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2016 |
Last Update Date | 08/02/2016 |