Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC007528-L | PA |
Y | 111NI0013X | Independent Medical Examiner | DC007528-L | PA |
NPI | 1912147224 |
---|---|
Provider Name | Robert Anthony Bogac |
First Address | Herminie, PA 15637-1441 |
Second Address | Herminie, PA 15637-1441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 26/02/2009 |