Provider Demographics
NPI:1356450274
Name:VAN DYCK, NEIL ALAN (DPM)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:ALAN
Last Name:VAN DYCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 OAK RIDGE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3427
Mailing Address - Country:US
Mailing Address - Phone:916-786-3434
Mailing Address - Fax:916-786-6770
Practice Address - Street 1:311 OAK RIDGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3427
Practice Address - Country:US
Practice Address - Phone:916-786-3434
Practice Address - Fax:916-786-6770
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2481213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4816019Medicaid
CA0955670001Medicare NSC
CA4816019Medicaid
CA000E24810Medicare PIN