Provider Demographics
NPI:1427429950
Name:VAN DYKE, AMOZ ISAAC (ND)
Entity type:Individual
Prefix:
First Name:AMOZ
Middle Name:ISAAC
Last Name:VAN DYKE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E SANOS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7427
Mailing Address - Country:US
Mailing Address - Phone:480-289-1566
Mailing Address - Fax:
Practice Address - Street 1:2152 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1751
Practice Address - Country:US
Practice Address - Phone:480-422-1662
Practice Address - Fax:480-970-0003
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1601175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath