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Organization
SOUTHPORT CHIROPRACTIC OFFICE, P.C.
Active
Organization
SOUTHPORT CHIROPRACTIC OFFICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS S. BOGANNAM S BOGANNAM DC (PRESIDENT)
(203) 259-4731
Entity
Organization
Contact information
Practice address
1995 POST RD, FAIRFIELD, CT 06824-5723
(203) 259-4731
(203) 259-7319
Mailing address
1995 POST RD, FAIRFIELD, CT 06824-5723
(203) 259-4731
(203) 259-7319
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
—
NULL
111NN1001X
Nutrition Chiropractor
Primary
—
—
Other
Enumeration date
07/25/2007
Last updated
11/10/2010
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