Provider Demographics
NPI:1235183138
Name:VOGEL, GREG JASON (DC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:JASON
Last Name:VOGEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 S VAL VISTA DR
Mailing Address - Street 2:#105
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3157
Mailing Address - Country:US
Mailing Address - Phone:480-497-2900
Mailing Address - Fax:480-497-2906
Practice Address - Street 1:754 S VAL VISTA DR
Practice Address - Street 2:#105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3157
Practice Address - Country:US
Practice Address - Phone:480-497-2900
Practice Address - Fax:480-497-2906
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU91267Medicare UPIN
AZZ110269Medicare PIN