Provider Demographics
NPI:1073560421
Name:VANDYKE, MICHELE H (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:H
Last Name:VANDYKE
Suffix:
Gender:F
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:P.O. BOX 351
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92402-0351
Mailing Address - Country:US
Mailing Address - Phone:909-890-1888
Mailing Address - Fax:909-890-0196
Practice Address - Street 1:1881 COMMERCENTER E
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3442
Practice Address - Country:US
Practice Address - Phone:909-890-1888
Practice Address - Fax:909-890-0196
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor