John J Bogannam, DC Valid NPI
Individual provider · Chiropractor · Trumbull, CT
- NPI
- 1821106154
- Type
- Individual (Type 1)
- Primary specialty
- Chiropractor
- Specialty group
- Chiropractic Providers
- Taxonomy code
- 111N00000X
- License number
- 000493 (CT)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2006-08-28
- Last updated
- 2007-07-08
Practice location
4154 Madison Avenue
Trumbull, CT 06611-3563
(203) 374-5560