Provider Demographics
NPI:1053710806
Name:VANDERVEEN, EMILY RUTH (DC)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:RUTH
Last Name:VANDERVEEN
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 1:121 MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ESPERANCE
Mailing Address - State:NY
Mailing Address - Zip Code:12066
Mailing Address - Country:US
Mailing Address - Phone:518-209-6420
Mailing Address - Fax:
Practice Address - Street 1:645 SHELDON ROAD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053
Practice Address - Country:US
Practice Address - Phone:518-209-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012554-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor