Provider Demographics
NPI:1619963717
Name:VAN DEHEY, DAVID W (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:VAN DEHEY
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 1:1230 ARMOUR RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2106
Mailing Address - Country:US
Mailing Address - Phone:815-933-5688
Mailing Address - Fax:815-933-3512
Practice Address - Street 1:1230 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2106
Practice Address - Country:US
Practice Address - Phone:815-933-5688
Practice Address - Fax:815-933-3512
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4682110OtherBLUE CROSS
ILT38649Medicare UPIN
ILK03770Medicare ID - Type Unspecified