Provider Demographics
NPI:1063855203
Name:VANDYKE, JASEN TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:JASEN
Middle Name:TODD
Last Name:VANDYKE
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 1:6 PARK PL W
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3081
Mailing Address - Country:US
Mailing Address - Phone:828-883-8262
Mailing Address - Fax:828-883-8264
Practice Address - Street 1:6 PARK PL W
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3081
Practice Address - Country:US
Practice Address - Phone:828-883-8262
Practice Address - Fax:828-883-8264
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3818111N00000X
NC4464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor