Provider Demographics
NPI:1518367754
Name:VAN SKYHOCK CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:VAN SKYHOCK CHIROPRACTIC CENTER
Other - Org Name:VAN SKYHOCK FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SKYHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-922-0219
Mailing Address - Street 1:3860 N LONG LAKE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7204
Mailing Address - Country:US
Mailing Address - Phone:231-922-0219
Mailing Address - Fax:231-922-0224
Practice Address - Street 1:3860 N LONG LAKE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7204
Practice Address - Country:US
Practice Address - Phone:231-922-0219
Practice Address - Fax:231-922-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009140261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1080584Medicare PIN