Provider Demographics
NPI:1346450202
Name:FOGG, LUKE E JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:E
Last Name:FOGG
Suffix:JR
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 1:57 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1408
Mailing Address - Country:US
Mailing Address - Phone:856-769-7700
Mailing Address - Fax:856-769-7900
Practice Address - Street 1:57 EAST AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1408
Practice Address - Country:US
Practice Address - Phone:856-769-7700
Practice Address - Fax:856-769-7900
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00571900111NI0013X, 111NS0005X
NC38MC00571900111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2465779OtherAETNA
NJFO043704Medicare ID - Type Unspecified