Healthcare Provider Details

I. General information

NPI: 1871598557
Provider Name (Legal Business Name): CHRISTOPHER J. VANDELUNE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAPLE ST
CHEROKEE IA
51012-1814
US

IV. Provider business mailing address

115 E MAPLE ST
CHEROKEE IA
51012-1814
US

V. Phone/Fax

Practice location:
  • Phone: 712-225-9003
  • Fax: 712-225-9004
Mailing address:
  • Phone: 712-225-9003
  • Fax: 712-225-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03566
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: