Provider Demographics
NPI:1801180195
Name:FOGEL CLINICS, LLC
Entity Type:Organization
Organization Name:FOGEL CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-835-8701
Mailing Address - Street 1:422 WHITTECAR AVE
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533-1341
Mailing Address - Country:US
Mailing Address - Phone:605-835-8701
Mailing Address - Fax:605-835-9124
Practice Address - Street 1:422 WHITTECAR AVE
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533-1341
Practice Address - Country:US
Practice Address - Phone:605-835-8701
Practice Address - Fax:605-835-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS105046Medicare PIN