Provider Demographics
NPI:1467525071
Name:VAN WYK, TREVOR (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:VAN WYK
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 1:7950 S LINCOLN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2713
Mailing Address - Country:US
Mailing Address - Phone:303-794-8754
Mailing Address - Fax:303-797-7262
Practice Address - Street 1:7950 S LINCOLN ST STE 104
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2713
Practice Address - Country:US
Practice Address - Phone:303-794-8754
Practice Address - Fax:303-797-7262
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU98253Medicare UPIN
COC520708Medicare ID - Type UnspecifiedMEDICARE - GROUP NUMBER
COC520728Medicare ID - Type UnspecifiedMEDICARE - MAIN NUMBER