Organization
KENNETH W VAN WYK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH W VAN WYK D.C. (OWNER)
(641) 628-3511
Entity
Organization
Contact information
Practice address
911 WASHINGTON ST, PELLA, IA 50219-1503
(641) 628-3511
(641) 628-1055
Mailing address
911 WASHINGTON ST, PELLA, IA 50219-1503
(641) 628-3511
(641) 628-1055
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0280271
—
IA
01
—
28027
BLUE SHIELD
IA
Enumeration date
03/13/2007
Last updated
12/05/2007
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