Provider Demographics
NPI:1467498287
Name:VOGT, MICHAEL E (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:VOGT
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 1:1755 W BROADWAY ST
Mailing Address - Street 2:STE 4
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4201
Mailing Address - Country:US
Mailing Address - Phone:407-365-8300
Mailing Address - Fax:
Practice Address - Street 1:1755 W BROADWAY ST
Practice Address - Street 2:STE 4
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4201
Practice Address - Country:US
Practice Address - Phone:407-365-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOO6063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380229500Medicaid
FL22514Medicare ID - Type Unspecified
FL380229500Medicaid