Provider Demographics
NPI:1669004313
Name:VANACKER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:VANACKER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-705-4410
Mailing Address - Street 1:213 MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-2905
Mailing Address - Country:US
Mailing Address - Phone:315-705-4410
Mailing Address - Fax:
Practice Address - Street 1:213 MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2905
Practice Address - Country:US
Practice Address - Phone:315-705-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty