Provider Demographics
NPI:1447387121
Name:VAN DYKE, DAVID P (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:VAN DYKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:P
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D C
Mailing Address - Street 1:1150 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2914
Mailing Address - Country:US
Mailing Address - Phone:805-514-2727
Mailing Address - Fax:805-541-2729
Practice Address - Street 1:1150 GROVE ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2914
Practice Address - Country:US
Practice Address - Phone:805-541-2727
Practice Address - Fax:805-541-2729
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18264Medicare ID - Type Unspecified
CATO1439Medicare UPIN