Provider Demographics
NPI:1285831610
Name:VOGEL, LORY WEBSTER (DC)
Entity Type:Individual
Prefix:DR
First Name:LORY
Middle Name:WEBSTER
Last Name:VOGEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E GANSEVOORT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1539
Mailing Address - Country:US
Mailing Address - Phone:315-823-4572
Mailing Address - Fax:315-823-4572
Practice Address - Street 1:595 E GANSEVOORT ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1539
Practice Address - Country:US
Practice Address - Phone:315-823-4572
Practice Address - Fax:315-823-4572
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004400-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26678Medicare UPIN
NY1C50231CMedicare ID - Type UnspecifiedPTAN