Provider Demographics
NPI:1457440885
Name:VANBLARICUM, TROY ALAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:ALAN
Last Name:VANBLARICUM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 E US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:IL
Mailing Address - Zip Code:62868-2407
Mailing Address - Country:US
Mailing Address - Phone:618-843-3855
Mailing Address - Fax:
Practice Address - Street 1:1303 W EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1619
Practice Address - Country:US
Practice Address - Phone:217-342-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer