Provider Demographics
NPI:1831651777
Name:VANVOLKENBURG, M JR (DC)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:
Last Name:VANVOLKENBURG
Suffix:JR
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 1:2140 EGGERT RD STE B
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2055
Mailing Address - Country:US
Mailing Address - Phone:716-832-1818
Mailing Address - Fax:
Practice Address - Street 1:2140 EGGERT RD STE B
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2055
Practice Address - Country:US
Practice Address - Phone:716-832-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor