Provider Demographics
NPI:1770114415
Name:VOGEL, CHULALUCK (DAC, LAC)
Entity type:Individual
Prefix:DR
First Name:CHULALUCK
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:DR
Other - First Name:CHULA
Other - Middle Name:
Other - Last Name:PUWACHAROEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAC, LAC
Mailing Address - Street 1:950 CITRINE WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3850
Mailing Address - Country:US
Mailing Address - Phone:808-366-0243
Mailing Address - Fax:
Practice Address - Street 1:2101 CONCORD BLVD STE E
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2055
Practice Address - Country:US
Practice Address - Phone:410-402-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02681171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist