Dykstra Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301009329 Issued in MI

Legal business name

DYKSTRA CHIROPRACTIC PC

Practice address

4072 Chicago Dr SW
Grandville, MI 49418-1291

Phone

(616) 531-6050

Fax

(616) 531-6053

NPI assigned

Jun 21, 2007

Last updated

May 8, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ronda Lynn Vanderwall, DCNPI 1720107915

Title

Doctor of Chiropractic

Phone

(616) 531-6050

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronda Lynn Vanderwall, DC

  • Chiropractor
  • Grandville, MI
  • NPI 1720107915
  Medicare reassignment Authorized official
• Ronson Holliday Dykstra, DC

  • Chiropractor
  • Franklin, TN
  • NPI 1619927258
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494201600000",
    "number": "1952507626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4072 CHICAGO DR SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181291",
            "telephone_number": "616-531-6050",
            "fax_number": "616-531-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4072 CHICAGO DR SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181291",
            "telephone_number": "616-531-6050",
            "fax_number": "616-531-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYKSTRA CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2017-05-08",
        "status": "A",
        "authorized_official_last_name": "VANDERWALL",
        "authorized_official_first_name": "RONDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "616-531-6050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008861",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010292",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144842737",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason C Doublestein, DDS
• Derek Matthew Draft, DDS
• Payton Dueweke
• Molly R Duiven, PA C
• Ashley Dunlap, B.S.
• Abraham Eapen
• Sherah Janette Eavey, OD
• Calvin Daniel Ebels, O.D.
• Theresa Eddie, MA, CCC-SLP
• Emory Stewart Eddy, LLPC

• Chiropractor in Grandville, MI
• Providers in Grandville, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.