Provider Demographics
NPI:1477675205
Name:FREDERICK M. VOGEL, DC PC
Entity Type:Organization
Organization Name:FREDERICK M. VOGEL, DC PC
Other - Org Name:EAST DETROIT CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-774-1550
Mailing Address - Street 1:15300 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1012
Mailing Address - Country:US
Mailing Address - Phone:586-774-1550
Mailing Address - Fax:586-774-9583
Practice Address - Street 1:15300 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1012
Practice Address - Country:US
Practice Address - Phone:586-774-1550
Practice Address - Fax:586-774-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1071750Medicaid
0E060991951Medicare ID - Type Unspecified