Provider Demographics
NPI:1821326703
Name:DICKEYVILLE HEALTH SERVICES INCORPORATED
Entity Type:Organization
Organization Name:DICKEYVILLE HEALTH SERVICES INCORPORATED
Other - Org Name:VOGT FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-568-3985
Mailing Address - Street 1:200 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKEYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53808-9700
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3770012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1815Medicare PIN
WIU78335Medicare UPIN