Provider Demographics
NPI:1578612610
Name:VOGT, JOHN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
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 1:802 AVENIDA PICO
Mailing Address - Street 2:SUITE N
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5637
Mailing Address - Country:US
Mailing Address - Phone:949-291-4039
Mailing Address - Fax:
Practice Address - Street 1:802 AVENIDA PICO
Practice Address - Street 2:SUITE N
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5637
Practice Address - Country:US
Practice Address - Phone:949-291-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28441111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC28441AMedicare ID - Type Unspecified
CAV03562Medicare UPIN