Provider Demographics
NPI:1831511708
Name:VANDYKE, CASEY (DC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:BOGART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:208 W MAIN ST
Mailing Address - Street 2:P.O. BOX 224
Mailing Address - City:LAKE LEELANAU
Mailing Address - State:MI
Mailing Address - Zip Code:49653-5104
Mailing Address - Country:US
Mailing Address - Phone:231-256-2500
Mailing Address - Fax:
Practice Address - Street 1:208 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE LEELANAU
Practice Address - State:MI
Practice Address - Zip Code:49653-5104
Practice Address - Country:US
Practice Address - Phone:231-256-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor