Provider Demographics
NPI:1801943253
Name:VAN NOSTRAND, KEVIN MICHAEL (BS DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:VAN NOSTRAND
Suffix:
Gender:M
Credentials:BS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4828
Mailing Address - Country:US
Mailing Address - Phone:941-205-2180
Mailing Address - Fax:941-205-2181
Practice Address - Street 1:324 CROSS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4828
Practice Address - Country:US
Practice Address - Phone:941-205-2180
Practice Address - Fax:941-205-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65924OtherBCBS
FL65924OtherBCBS