Provider Demographics
NPI:1922378033
Name:DWAYNE G VOGEL DC PC
Entity Type:Organization
Organization Name:DWAYNE G VOGEL DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-652-4333
Mailing Address - Street 1:71 25TH ST W
Mailing Address - Street 2:STE6
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4684
Mailing Address - Country:US
Mailing Address - Phone:406-652-4333
Mailing Address - Fax:406-652-4041
Practice Address - Street 1:71 25TH ST W
Practice Address - Street 2:STE6
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4684
Practice Address - Country:US
Practice Address - Phone:406-652-4333
Practice Address - Fax:406-652-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0163215Medicaid
MT000004294Medicare PIN
MTU41863Medicare UPIN