Provider Demographics
NPI:1508931403
Name:VAN WYK, CHRIS A (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
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 1:5540 HORSESHOE TRAIL
Mailing Address - Street 2:P.O. BOX 842
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135
Mailing Address - Country:US
Mailing Address - Phone:303-795-3040
Mailing Address - Fax:
Practice Address - Street 1:7231 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8008
Practice Address - Country:US
Practice Address - Phone:303-794-8754
Practice Address - Fax:303-797-7262
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO350040737OtherRAILROAD MEDICARE
COVA12783OtherANTHEM BCBS
COCO400081Medicare PIN