Provider Demographics
NPI:1447387121
Name:VAN DYKE, DAVID P (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:VAN DYKE
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 1:1241 KNOLLWOOD CIRCLE
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-3343
Mailing Address - Country:US
Mailing Address - Phone:805-927-8631
Mailing Address - Fax:
Practice Address - Street 1:1241 KNOLLWOOD CIRCLE
Practice Address - Street 2:SUITE 201B
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3343
Practice Address - Country:US
Practice Address - Phone:805-927-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18264Medicare ID - Type Unspecified
CATO1439Medicare UPIN