Provider Demographics
NPI:1164643532
Name:VANNEDERYNEN, VICTORIA S (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:S
Last Name:VANNEDERYNEN
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 1:172 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3120
Mailing Address - Country:US
Mailing Address - Phone:607-592-4457
Mailing Address - Fax:508-655-6145
Practice Address - Street 1:264 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1141
Practice Address - Country:US
Practice Address - Phone:508-655-9008
Practice Address - Fax:508-651-3805
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor