Provider Demographics
NPI:1821719758
Name:VAN ECK, DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:VAN ECK
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 1:4 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2105
Mailing Address - Country:US
Mailing Address - Phone:201-669-1733
Mailing Address - Fax:
Practice Address - Street 1:1373 BROAD ST STE 202
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4231
Practice Address - Country:US
Practice Address - Phone:201-669-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00794200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor