Provider Demographics
NPI:1700992237
Name:VANDE VEEGAETE, JAIME L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:VANDE VEEGAETE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17108 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6239
Mailing Address - Country:US
Mailing Address - Phone:313-640-7888
Mailing Address - Fax:313-640-7890
Practice Address - Street 1:17108 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6239
Practice Address - Country:US
Practice Address - Phone:313-640-7888
Practice Address - Fax:313-640-7890
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJV008381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H254650OtherBLUE CROSS BLUE SHIELD MI
MI950H254650OtherBLUE CROSS BLUE SHIELD MI