Healthcare Provider Details

I. General information

NPI: 1578612610
Provider Name (Legal Business Name): JOHN ROBERT VOGT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 AVENIDA PICO SUITE N
SAN CLEMENTE CA
92673-5637
US

IV. Provider business mailing address

802 AVENIDA PICO SUITE N
SAN CLEMENTE CA
92673-5637
US

V. Phone/Fax

Practice location:
  • Phone: 949-291-4039
  • Fax:
Mailing address:
  • Phone: 949-291-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC28441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: