Provider Demographics
NPI:1447463260
Name:VANDE REE, BRIAN JON (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JON
Last Name:VANDE REE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 A AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4203
Mailing Address - Country:US
Mailing Address - Phone:641-673-7621
Mailing Address - Fax:641-672-0246
Practice Address - Street 1:1410 A AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4203
Practice Address - Country:US
Practice Address - Phone:641-673-7621
Practice Address - Fax:641-672-0246
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0002329Medicaid
IAU00938Medicare UPIN
IA0002329Medicaid