Provider Demographics
NPI:1962537365
Name:VAN SKYHOCK, HEATHER ANN (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:VAN SKYHOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S ELMWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3180
Mailing Address - Country:US
Mailing Address - Phone:231-922-0219
Mailing Address - Fax:231-922-0224
Practice Address - Street 1:415 S ELMWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3180
Practice Address - Country:US
Practice Address - Phone:231-922-0219
Practice Address - Fax:231-922-0224
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B81174OtherBLUE CROSS BLUE SHIELD
MI4696755Medicaid
MIP51670001Medicare PIN