Provider Demographics
NPI:1639348386
Name:TREVOR VAN WYK DC PC
Entity Type:Organization
Organization Name:TREVOR VAN WYK DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN WYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-794-8754
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC520708Medicare PIN