Provider Demographics
NPI:1467500041
Name:VAN DYKE, MICHAEL HAMPTON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HAMPTON
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 1:814 S 1040 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4614
Mailing Address - Country:US
Mailing Address - Phone:385-404-5489
Mailing Address - Fax:385-317-4241
Practice Address - Street 1:814 S 1040 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-4614
Practice Address - Country:US
Practice Address - Phone:385-404-5489
Practice Address - Fax:385-317-4241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6638349-1202111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor