Provider Demographics
NPI:1336127455
Name:VOJTECH, PEGGY SUE (DC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:VOJTECH
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 1:23640 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2904
Mailing Address - Country:US
Mailing Address - Phone:952-474-7402
Mailing Address - Fax:952-470-1003
Practice Address - Street 1:23640 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:MN
Practice Address - Zip Code:55331-2904
Practice Address - Country:US
Practice Address - Phone:952-474-7402
Practice Address - Fax:952-470-1003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C193SEOtherBLUE CROSS BLUE SHEILD
MNU456535Medicare UPIN