Provider Demographics
NPI:1184162042
Name:VANOVER, MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:VANOVER
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 1:135 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1137
Mailing Address - Country:US
Mailing Address - Phone:269-792-9952
Mailing Address - Fax:269-792-6459
Practice Address - Street 1:135 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1137
Practice Address - Country:US
Practice Address - Phone:269-792-9952
Practice Address - Fax:269-792-6459
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor