Provider Demographics
NPI:1871637025
Name:VAN SKYHOCK CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:VAN SKYHOCK CHIROPRACTIC CENTER, PC
Other - Org Name:VAN SKYHOCK FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VAN SKYHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-922-0219
Mailing Address - Street 1:415 S ELMWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3180
Mailing Address - Country:US
Mailing Address - Phone:231-922-0219
Mailing Address - Fax:231-922-0224
Practice Address - Street 1:415 S ELMWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3180
Practice Address - Country:US
Practice Address - Phone:231-922-0219
Practice Address - Fax:231-922-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4696755Medicaid
MI4696755Medicaid