Individual
MR. KENNETH BOGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CO
Contact information
Practice address
345 E SUPERIOR ST, SUITE 1764, CHICAGO, IL 60611-2654
(132) 238-2810
(312) 238-1932
Mailing address
2712 W FARWELL AVE, CHICAGO, IL 60645-4515
(773) 972-1136
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
213000065
IL
Other
Enumeration date
01/18/2010
Last updated
01/18/2010
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