Provider Demographics
NPI:1033511688
Name:VAN ROO FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VAN ROO FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN ROO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-756-5225
Mailing Address - Street 1:2505 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0441
Mailing Address - Country:US
Mailing Address - Phone:608-756-5225
Mailing Address - Fax:608-756-0506
Practice Address - Street 1:2505 MILTON AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0441
Practice Address - Country:US
Practice Address - Phone:608-756-5225
Practice Address - Fax:608-756-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty