Provider Demographics
NPI:1740822444
Name:VANPELT, AUDREY MAAIKE (DC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MAAIKE
Last Name:VANPELT
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 1:740 PRINCE AVE STE 8A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5903
Mailing Address - Country:US
Mailing Address - Phone:706-739-5552
Mailing Address - Fax:
Practice Address - Street 1:740 PRINCE AVE STE 8A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5903
Practice Address - Country:US
Practice Address - Phone:706-739-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010884111N00000X
GACHIRO10635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor