Provider Demographics
NPI:1073704722
Name:VAN DYCK, AARON DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:DAVID
Last Name:VAN DYCK
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 177
Mailing Address - Street 2:
Mailing Address - City:VERDUGO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91046-0177
Mailing Address - Country:US
Mailing Address - Phone:818-249-4226
Mailing Address - Fax:818-249-4206
Practice Address - Street 1:3011 HONOLULU AVE.
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3714
Practice Address - Country:US
Practice Address - Phone:818-249-4226
Practice Address - Fax:818-249-4206
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16662Medicare UPIN
CAWDC28601Medicare PIN