Provider Demographics
NPI:1245642206
Name:VANDERHYDE, NICHOLAS GENE (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GENE
Last Name:VANDERHYDE
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 1:321 STINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3268
Mailing Address - Country:US
Mailing Address - Phone:661-246-1407
Mailing Address - Fax:661-835-6217
Practice Address - Street 1:321 STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3268
Practice Address - Country:US
Practice Address - Phone:661-246-1407
Practice Address - Fax:661-835-6217
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor