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General NPI Number Information
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NPI Number | 1952507626
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Entity Type | Organization
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Legal Business Name | DYKSTRA CHIROPRACTIC PC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 4072 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1291
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Country | US
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Telephone | 616-531-6050
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Fax | 616-531-6053
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Provider Business Mailing Address
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Address Line | 4072 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1291
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Country | US
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Telephone | 616-531-6050
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Fax | 616-531-6053
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. RONDA LYNN VANDERWALL
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Credential | DC
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Telephone | 616-531-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301008861
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010292
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009329
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License Number State | MI
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