Provider Demographics
NPI:1497941082
Name:VANHOOGSTRAAT, MARC (DC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:VANHOOGSTRAAT
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 1:776 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5037
Mailing Address - Country:US
Mailing Address - Phone:248-628-4886
Mailing Address - Fax:248-628-5341
Practice Address - Street 1:776 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5037
Practice Address - Country:US
Practice Address - Phone:248-628-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMV007079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM10500Medicare PIN