Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4143-012 | WI |
NPI | 1003992835 |
---|---|
Provider Name | Dr. Eric Kenneth Bogaart |
First Address | Neenah, WI 54956-3617 |
Second Address | Neenah, WI 54956-3617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 15/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38964100 | (05) | WI |
V07842 | (02) | WI |