Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHOOO5125 | FL |
NPI | 1063431955 |
---|---|
Provider Name | Dr. Edward William Hoglund |
First Address | Merritt Island, FL 32953 |
Second Address | Merritt Island, FL 32953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHOOO5125 | LICENSE NUMBER (01) | FL |
T94460 | (02) | FL |