Provider Demographics
NPI:1447284815
Name:COGGINS, MICHAEL EDWARD JR (DC, PA-C)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:COGGINS
Suffix:JR
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022-0154
Mailing Address - Country:US
Mailing Address - Phone:805-415-3228
Mailing Address - Fax:
Practice Address - Street 1:2295 VALLEY MEADOW DR
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9562
Practice Address - Country:US
Practice Address - Phone:805-415-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24318111NS0005X
CAPA17691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA17691AMedicare ID - Type Unspecified
CADC24318Medicare ID - Type Unspecified
CAU78179Medicare UPIN