Provider Demographics
NPI:1760549349
Name:VOGEL, DWAYNE G (DC)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:G
Last Name:VOGEL
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 1:71 25TH STREET WEST SUITE 6
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:406-652-4333
Mailing Address - Fax:406-652-4041
Practice Address - Street 1:71 25TH STREET WEST SUITE 6
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-652-4333
Practice Address - Fax:406-652-4041
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0163215Medicaid
MT40183OtherBLUE CROSS BLUE SHIELD
350053108OtherRAILROAD MEDICARE
MT0163228OtherOVER 21 SERVICES MEDICAID
MT40183OtherBLUE CROSS BLUE SHIELD
350053108OtherRAILROAD MEDICARE