Provider Demographics
NPI:1528087574
Name:VOGEL, ROY JASON (DC)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:JASON
Last Name:VOGEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0069
Mailing Address - Country:US
Mailing Address - Phone:770-961-5577
Mailing Address - Fax:770-961-1407
Practice Address - Street 1:3695 CASCADE RD SW
Practice Address - Street 2:SUITE R
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2146
Practice Address - Country:US
Practice Address - Phone:404-699-1129
Practice Address - Fax:404-699-7827
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR003137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00224955OtherRAILROAD MEDICARE
GA35ZCCKHMedicare ID - Type Unspecified
GAP00224955OtherRAILROAD MEDICARE
GAU20837Medicare UPIN