Healthcare Provider Details

I. General information

NPI: 1235183138
Provider Name (Legal Business Name): GREG JASON VOGEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S VAL VISTA DR #105
GILBERT AZ
85296-3157
US

IV. Provider business mailing address

754 S VAL VISTA DR #105
GILBERT AZ
85296-3157
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2900
  • Fax: 480-497-2906
Mailing address:
  • Phone: 480-497-2900
  • Fax: 480-497-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7708
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: