Provider Demographics
NPI:1881720977
Name:VANSKYHOCK, JUSTIN ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ALLAN
Last Name:VANSKYHOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S ELMWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3180
Mailing Address - Country:US
Mailing Address - Phone:231-922-0219
Mailing Address - Fax:231-922-0224
Practice Address - Street 1:415 S ELMWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3180
Practice Address - Country:US
Practice Address - Phone:231-922-0219
Practice Address - Fax:231-922-0224
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B81168OtherBLUE CROSS BLUE SHIELD
MIP51670002Medicare PIN