Healthcare Provider Details

I. General information

NPI: 1366218612
Provider Name (Legal Business Name): JOSEPH DOUGLAS VANDUYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EAGLE RIDGE RD
LE CLAIRE IA
52753-9593
US

IV. Provider business mailing address

250 W JAMES ST
WALCOTT IA
52773-8552
US

V. Phone/Fax

Practice location:
  • Phone: 563-289-3241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number122745
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: