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Individual
DR. MICHAEL F VANDEWALLE
Active
Individual
DR. MICHAEL F VANDEWALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
04589
IA
111N00000X
Chiropractor
Primary
DC2771
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2771
STATE LICENSE
TX
01
—
8P0221
BCBS
TX
05
—
C06060612
—
TX
Enumeration date
08/04/2006
Last updated
11/02/2016
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