Individual
DR. NICHOLAS S BOGANNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
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
111N00000X
Chiropractor
Primary
253CT01
CT
111NN1001X
Nutrition Chiropractor
253CT01
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-1066319
TAX ID #
CT
01
—
253CT01
STATE LICENSE NUMBER
CT
Enumeration date
12/06/2006
Last updated
09/08/2010
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