Provider Demographics
NPI:1770571564
Name:VOGEL CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:VOGEL CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUDI
Authorized Official - Middle Name:EWING
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-788-4778
Mailing Address - Street 1:1780 S NOVA RD
Mailing Address - Street 2:STE 4
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1777
Mailing Address - Country:US
Mailing Address - Phone:386-788-4778
Mailing Address - Fax:386-788-8110
Practice Address - Street 1:1780 S NOVA RD
Practice Address - Street 2:STE 4
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1777
Practice Address - Country:US
Practice Address - Phone:386-788-4778
Practice Address - Fax:386-788-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CH0006899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0018GOtherBLUE CROSS/BLUE SHIELD
350055155OtherMEDICARE RAILROAD
K2571Medicare PIN
U54573Medicare UPIN