Healthcare Provider Details

I. General information

NPI: 1093891962
Provider Name (Legal Business Name): DOUGLAS J. VANVORST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 STATE HIGHWAY 30
AMSTERDAM NY
12010-7532
US

IV. Provider business mailing address

402 UNION ST
SCHENECTADY NY
12305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-2374
  • Fax:
Mailing address:
  • Phone: 518-374-7555
  • Fax: 518-374-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number004774-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: