Provider Demographics
NPI:1689662470
Name:VOGEL, TRUDI EWING (DC)
Entity Type:Individual
Prefix:DR
First Name:TRUDI
Middle Name:EWING
Last Name:VOGEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TRUDI
Other - Middle Name:FRANCES
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1780 S NOVA RD
Mailing Address - Street 2:STE 4
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1777
Mailing Address - Country:US
Mailing Address - Phone:386-788-4778
Mailing Address - Fax:386-788-8110
Practice Address - Street 1:1780 S NOVA RD
Practice Address - Street 2:STE 4
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1777
Practice Address - Country:US
Practice Address - Phone:386-788-4778
Practice Address - Fax:386-788-8110
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0771384OtherCIGNA
353748OtherAVMED
55270OtherBLUE CROSS BLUE SHIELD
350055155OtherMEDICARE RAILROAD
0000224084OtherFLORIDA HEALTHCARE
350055155OtherMEDICARE RAILROAD
FL0771384OtherCIGNA