Provider Demographics
NPI:1720257546
Name:CHRIS A VAN WYK DC PC
Entity Type:Organization
Organization Name:CHRIS A VAN WYK DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN WYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-794-8754
Mailing Address - Street 1:7231 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-8008
Mailing Address - Country:US
Mailing Address - Phone:303-794-8754
Mailing Address - Fax:303-797-7262
Practice Address - Street 1:7231 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8008
Practice Address - Country:US
Practice Address - Phone:303-794-8754
Practice Address - Fax:303-797-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODN7985OtherRAILROAD MEDICARE
COCOB4078Medicare PIN