Provider Demographics
NPI:1689984049
Name:VAN SKYHOCK CHIROPRACTIC HEALTH CENTER LLC
Entity Type:Organization
Organization Name:VAN SKYHOCK CHIROPRACTIC HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN SKYHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-885-3220
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-0094
Mailing Address - Country:US
Mailing Address - Phone:231-885-3220
Mailing Address - Fax:231-326-2112
Practice Address - Street 1:111 E EDWARD ST
Practice Address - Street 2:
Practice Address - City:MESICK
Practice Address - State:MI
Practice Address - Zip Code:49668-9575
Practice Address - Country:US
Practice Address - Phone:231-885-3220
Practice Address - Fax:231-326-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3246Medicare PIN
MIMI3246001Medicare PIN