Provider Demographics
NPI:1790783546
Name:VOGT, BEN A (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:A
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:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:DICKEYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53808-0340
Mailing Address - Country:US
Mailing Address - Phone:608-568-3985
Mailing Address - Fax:608-568-3987
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKEYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53808-9700
Practice Address - Country:US
Practice Address - Phone:608-568-3985
Practice Address - Fax:608-568-3987
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3770-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU78335Medicare UPIN
WIWI1815001Medicare PIN