Provider Demographics
NPI:1699820241
Name:VANDERSLUIS, MICHAEL ALBERT
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALBERT
Last Name:VANDERSLUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2072 B EAST COMMERCIAL
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2303
Mailing Address - Country:US
Mailing Address - Phone:219-696-8916
Mailing Address - Fax:
Practice Address - Street 1:2072 B EAST COMMERCIAL
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2303
Practice Address - Country:US
Practice Address - Phone:219-696-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001442A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000380552Medicare UPIN