Provider Demographics
NPI:1932265931
Name:VAN BUSKIRK, WILLIAM JOHN (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:VAN BUSKIRK
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:PO BOX 1709
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1709
Mailing Address - Country:US
Mailing Address - Phone:505-368-4568
Mailing Address - Fax:505-368-4502
Practice Address - Street 1:HWY 491 SUITE 6
Practice Address - Street 2:SHIPROCK SHOPPING CENTER
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-4568
Practice Address - Fax:505-368-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU18403Medicare UPIN
NM$$$$$$$$$PMedicare PIN