Provider Demographics
NPI:1861630055
Name:VANBOSKIRK, DONALD J (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:VANBOSKIRK
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 1:1105 BRIDGE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1634
Mailing Address - Country:US
Mailing Address - Phone:717-440-4085
Mailing Address - Fax:
Practice Address - Street 1:1105 BRIDGE ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1634
Practice Address - Country:US
Practice Address - Phone:717-440-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004542L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician